The Safety Action Feedback and Engagement (SAFE) Loop: Initial Testing and Refinement of a Novel Intervention to...

Voluntary incident reporting has improved safety in many high-risk industries, but barriers limit its effectiveness in hospitals. To overcome these, we designed the Safety Action Feedback and Engagement (SAFE) Loop to obtain input from nurses about and prioritize patient safety problems, teach nurses to write more informative reports and report priority incidents, standardize investigations, and provide feedback to nurses about mitigation plans. The present work sought to iteratively test and refine the nascent intervention.

Set at a large US academic hospital, this work had 3 phases: (A) proof-of-concept testing on 2 nursing units, exploring potential feasibility and acceptability; (B) iterative refinements to intervention design and implementation plans; and (C) structured pilot testing on one nursing unit to produce descriptive and qualitative data related to the feasibility and acceptability of the refined intervention, and feasibility of future outcome measures.

Proof-of-concept testing demonstrated the feasibility of intervention elements and nurses' enthusiasm. Incorporating iterative refinements, the structured pilot testing reaffirmed the feasibility of implementing the full SAFE Loop intervention and of collecting outcome data. Qualitative interviews after the pilot reaffirmed intervention acceptability.

The SAFE Loop shows promise as an approach to enhancing hospital incident reporting systems. The present work illustrates how patient safety leaders can build from an initial intervention design toward a refined design and implementation plan, with demonstrated acceptability to stakeholders and feasible implementation.