A Decade of Preventing Harm.

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Medical Error Reduction

Background:

• Medical errors significantly contribute to patient morbidity and mortality.
• Sustaining reductions in patient harm across various categories presents an ongoing challenge.
• BJC HealthCare launched a systemwide initiative in 2008 to eliminate preventable harm and mortality.

Purpose of the Study:

• To implement and sustain a systemwide program aimed at eliminating major causes of preventable patient harm and mortality.
• To achieve and maintain reductions in patient harm over a ten-year period (five years of intervention and five years of sustainment).

Main Methods:

• Focused on key areas: pressure ulcers, adverse drug events, falls with injury, healthcare-associated infections, and venous thromboembolism.
• Established system-level multidisciplinary teams, standardized project management, and surveillance methods.
• Deployed evidence-based interventions with core standards and local implementation flexibility; tracked events using actual numbers.

Main Results:

• Total harm events decreased by 51.6% from 2009 to 2012 (10,371 to 5,018 events).
• Continued efforts resulted in a further reduction to 2,605 events by 2017, a 74.9% decrease since 2009.
• Demonstrated long-term sustainment of harm reduction over the subsequent five years.

Conclusions:

• A combination of project management discipline, rigorous surveillance, and focused interventions drove significant reductions in preventable harm.
• System-level support for local improvement efforts was crucial for achieving and sustaining progress.
• The initiative successfully reduced patient harm and mortality, demonstrating the effectiveness of a sustained, systemwide approach.