Safety Officer: Hospitalist Support of Safety Practices on a Pediatric Surgical Unit

A quality improvement initiative targeting emergency transfer (ET) rate reduction resulted in the development and implementation of the safety officer (SO) intervention. SO leveraged on-site pediatric hospitalists to promote institutional safety practices around care escalation for all patients admitted to the target unit, including those admitted to surgical subspecialty services.

An interdisciplinary team developed the SO intervention, which included ad hoc support of communication algorithms and attendance at all Rapid Response Team (RRT) activations on the target unit. To evaluate SO implementation, we applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We obtained data through postimplementation surveys, manual case review, and electronic health record reporting. We analyzed survey data using descriptive statistics and clinical data using statistical process control charts.

Most SOs completed training (85%). The survey response rate was 30%; 40% were hospitalist clinicians, 24% were RRT participants, 18% were surgeons, and 18% were bedside nurses. Many respondents believed SO improved the unit's safety culture (56%). Nurses reported improved ability to escalate care (94%), and intensive care unit clinicians reported enhanced RRT practices. SO involvement in RRTs increased from 0% to 78%. Non-SO clinicians did not believe SO detracted from ownership of their patients (97%), and SOs felt they could effectively balance competing responsibilities (92%). We did not observe a change in ET rates.

By implementing the SO intervention, we successfully integrated hospitalists for managing care escalations and improved perceived safety culture. Further study is needed to evaluate whether SO can improve rare adverse events like ETs.