Co-creating patient safety education: Bridging learning, practice, and policy in emergency care

Pre-analytical errors persist as the leading cause of laboratory errors despite technological advances, reflecting translational failures in continuing professional development (CPD). Traditional patient safety education, such as didactic lectures and online learning modules, achieves only temporary improvements, with error rates returning to baseline within months. Co-creation, where frontline professionals function as equal partners in educational design, offers a fundamentally distinct approach, yet evidence regarding operationalization, sustained clinical outcomes, and departmental policy integration remains limited.

To evaluate a co-created CPD program addressing persistent pre-analytical errors in an emergency department where prior interventions had failed.

We conducted a pre-post quasi-experimental design at a tertiary-care teaching hospital in Taiwan from August 2021 through August 2024. The co-created program involved nurses, medical technologists, educators, and administrators across four learning sessions: case-based learning, online modules, simulation, and three-stage structured practice improvement process. We employed the New World Kirkpatrick Model for comprehensive evaluation, analyzing 141,927 specimens over 25 months. Evaluation outcomes included engagement, satisfaction, knowledge, skills, procedural compliance, error rates, and departmental policy integration.

The program achieved sustained 50% reduction in pre-analytical error rates from 1.15% to 0.59% (p < 0.001) maintained over 10 months, representing 240 fewer errors. This was supported by exceptional engagement (85-100% participation), high satisfaction (mean ≥4.2/5.0), significant knowledge and skills gains (p < 0.05), and 50% reduction in non-compliance rates from 1.87% to 0.93% (p < 0.001). Critically, participant-generated innovations, including automated hemolysis surveillance system and revised procedures, were formally integrated into departmental standard operating procedures and training curricula.

Co-creation achieved sustained patient safety improvements through behavior change and departmental policy integration. Interprofessional learning and three-stage structured practice improvement process demonstrate co-creation's effectiveness in transforming CPD learning. This study provides a replicable model for bridging gaps between patient safety knowledge and practice.