Reformulating real-time random safety analysis during the SARS-CoV-2 pandemic

From a safety perspective, the pandemic imposed atypical work dynamics that led to noticeable gaps in clinical safety across all levels of health care.

To verify that Real-Time Random Safety Analyses (AASTRE) are feasible and useful in a high-pressure care setting.

Prospective study (January-September 2022).

University Hospital with 350 beds. Two mixed ICUs (12 and 14 beds).

Two safety audits per week were planned to determine the feasibility and usefulness of the 32 safety measures (grouped into 8 blocks).

1) Feasibility: Proportion of completed audits compared to scheduled audits and time spent. 2) Utility: Changes in the care process made as a result of implementing AASTRE.

A total of 390 patient-days were analyzed (179 were Non-COVID patients and 49 were COVID patients). In the COVID patient subgroup, age, ICU stay, SAPS 3, and ICU mortality were significantly higher compared to the Non-COVID patient subgroup. Regarding feasibility, 93.8% of planned rounds were carried out with an average audit time of 25 ± 8 min. Overall, changes in the care process were made in 11.8% of the measures analyzed.

In a high-complexity care environment, AASTRE proved to be a feasible and useful tool with only two interventions per week lasting less than 30 min. Overall, AASTRE allowed unsafe situations to be turned safe in more than 10% of the evaluations.