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

Area of Science:

• Healthcare Management
• Patient Safety
• Critical Care Medicine

Background:

• The COVID-19 pandemic created atypical healthcare dynamics, leading to significant clinical safety gaps.
• High-pressure care environments pose unique challenges to maintaining patient safety standards.

Purpose of the Study:

• To assess the feasibility and utility of Real-Time Random Safety Analyses (AASTRE) in a high-pressure intensive care setting.
• To determine if AASTRE can effectively identify and address safety concerns in complex healthcare environments.

Main Methods:

• A prospective study was conducted from January to September 2022 in two mixed intensive care units (ICUs) at a university hospital.
• Two safety audits per week were performed to evaluate 32 safety measures using the AASTRE methodology.
• Feasibility was measured by audit completion rates and time spent, while utility was assessed by changes made to care processes.

Main Results:

• The study analyzed 390 patient-days, including 49 COVID-19 patients who exhibited higher age, ICU stay, SAPS 3 scores, and mortality.
• Feasibility was high, with 93.8% of planned audits completed in an average of 25 minutes.
• Implemented AASTRE led to process changes in 11.8% of evaluated safety measures.

Conclusions:

• Real-Time Random Safety Analyses (AASTRE) is a feasible and useful tool for enhancing patient safety in high-complexity care settings.
• With just two brief weekly audits, AASTRE effectively converted over 10% of evaluated unsafe situations into safe practices.
• The AASTRE methodology provides a valuable framework for continuous safety improvement in ICUs, even under demanding conditions.