The Impact of Semistructured Safety-Focused Site Visits Between Children's Hospitals

Site visits are commonly used for accreditation and regulatory purposes, but little is known about how hospitals use them for safety improvement or their impact on clinical processes and outcomes.

This mixed methods study describes the key components of safety-focused site visits between hospitals and their impact on hospital safety outcomes, particularly for the visiting hospital. Hospitals were recruited via the Children's Hospitals' Solutions for Patient Safety (SPS) Network. A site visit guide was developed, covering pre-visit planning, visit execution, and post-visit debriefing. A post-visit survey and follow-up interviews (6 to 12 months later) were conducted. Themes were identified using a constant comparative approach, and statistical analysis compared rates of hospital-acquired conditions (HACs) between hospitals that participated in site visits and those that did not.

From 2019 to 2021, 27 hospitals (19.6%) participated in site visits, with 14 in-person and 13 virtual. Key themes to drive a successful and useful visit highlighted the importance of peer rapport, interaction with frontline staff, structured planning, clear agendas, and thorough debriefing. Among hospitals that completed a follow-up interview, 76.5% completed at least one action item, with 56.8% of pre-determined SMART aims achieved. However, no significant difference in HAC rates, specifically central line-associated bloodstream infections (CLABSIs) and unplanned extubations (UEs), was found between site visit and non-site visit hospitals.

Safety-focused site visits between hospitals provide a valuable learning experience, fostering the development of improvement strategies and high rates of action item completion. However, no significant differences in safety outcomes were observed, likely due to the small sample size.