Related Experiment Video
Updated: Nov 7, 2025
06:05
The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
Published on: February 19, 2021
1.5K
How can Never Event data be used to reflect or improve hospital safety performance?
J Olivarius-McAllister1, M Pandit1, A Sykes1,1
1Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Anaesthesia
|May 1, 2021
Summary
UK regulators incorrectly use the absolute number of Never Events to assess hospital safety. This method is mathematically invalid because it ignores hospital workload, leading to inaccurate performance evaluations.
Area of Science:
- Healthcare quality and safety
- Medical statistics
- Health services research
Background:
- UK regulators use the absolute number of Never Events to evaluate hospital safety performance.
- This approach does not account for variations in hospital workload, potentially skewing assessments.
Purpose of the Study:
- To assess the validity of using absolute Never Event numbers for hospital performance evaluation.
- To investigate the impact of hospital workload on Never Event rates using funnel plots.
Main Methods:
- Analysis of published Never Event data from 151 NHS England acute Trusts (2017-2020).
- Application of funnel plots to account for hospital workload (finished consultant episodes).
- Correlation analysis between absolute Never Event numbers and workload.
Main Results:
- A significant correlation was found between Never Events and workload (r² = 0.51, p < 0.001).
- Hospitals with statistically excess Never Event rates did not consistently have the highest absolute numbers.
- Data exhibited skewness, with 12 out of 151 Trusts falling below the lower confidence limit.
Conclusions:
- Current regulatory use of absolute Never Event numbers for judging hospital performance is mathematically unsound.
- A shift is needed from identifying outlier hospitals to reducing the national average Never Event rate.
- Promoting shared learning and a system-wide approach is crucial for improving overall patient safety.
Related Concept Videos
01:21Types of Reports II: Incident or Occurrence Report
999
An Incident or Occurrence Report in a healthcare setting is a crucial document used to record any unexpected occurrence that may or may not have affected a patient, employee, or visitor. Such reports are critical to improving patient safety and include all details leading up to and including the event.
Purposes:
In the healthcare industry, reports play a crucial role in documenting incidents within an agency. The primary objective of these reports is to ensure patient safety, uphold the...
Purposes:
In the healthcare industry, reports play a crucial role in documenting incidents within an agency. The primary objective of these reports is to ensure patient safety, uphold the...
999
01:18Guidelines and Strategies for Safe Computer Charting
1.2K
The guidelines and strategies provided by the American Nurses Association (ANA) and the Canadian Nurses Association (CNA) offer essential principles for ensuring safe and secure computer charting systems in healthcare settings. Let's break down each recommendation:
Maintain Confidentiality and Security:
Maintain Confidentiality and Security:
1.2K
01:22Healthcare Associated Infections II: Preventive Measures
3.3K
Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
3.3K
01:24Data Reporting and Recording
5.1K
Reporting and recording are crucial in data documentation. The timely, thorough, and accurate documentation of facts is essential when recording patient data. Failure to record findings during an assessment or interpretation of a problem will result in loss of information and make the patient document unreliable. The reader is left with general impressions if the information is not specific. A recording is documenting data of the individual's health information in a traceable, secure, and...
5.1K
01:11Purpose of Health Records I
1.5K
The vital purpose of health records is to provide a complete and accurate account of a patient's medical history, including communication, diagnostic and therapeutic orders, care planning, research, and quality review.
Here's a breakdown of how health records serve these purposes:
Here's a breakdown of how health records serve these purposes:
1.5K
01:25Ethical Standards I
1.2K
The American Nurses Association (ANA) created and implemented the first nationally accepted Code of Ethics for Nurses with Interpretive Statements. The Code of Ethics is a living document regularly updated by the ANA and establishes an ethical standard that is non-negotiable for nurses in all roles and settings.
The Code of Ethics provisions outline the nurse's duty to the patient, the healthcare team, the profession, and society. The Code's fundamental principles include advocacy,...
The Code of Ethics provisions outline the nurse's duty to the patient, the healthcare team, the profession, and society. The Code's fundamental principles include advocacy,...
1.2K