Use of Safety Stand-Down Initiatives to Reduce Hospital Harm Events

Continuous improvement with short-cycle process change has become an accepted and commonly practiced quality tool in health care settings. While these improvement cycles had somewhat reduced our hospital's harm events over the years, patients continued to experience them. Staff and leaders were preoccupied with multiple competing priorities, especially in the aftermath of the COVID-19 pandemic. We report the use of safety stand-down initiatives to focus team attention and complement overall improvement efforts.

The safety stand-down concept was adapted from industry to rapidly focus attention on safety and further reduce hospital harm events. We describe a stand-down process that harnesses stakeholder commitment, team attention, and resources so that stand-down actions can be initiated quickly. Four hospital-wide and 3 unit-based safety stand-downs were initiated in response to outliers or rapidly rising counts of hospital-acquired Clostridioides difficile infection, central line-associated bloodstream infection (CLABSI), and inpatient falls. Run charts were used to compare performance 12 months before and 6 to 9 months after the hospital-wide stand-down interventions.

Postintervention, C difficile infections, CLABSIs, and inpatient falls improved significantly based on meeting the run chart rules for constituting a shift. Reductions (39.2%, 78.9%, and 20.4%, respectively) were statistically significant at the P<0.05 level.

Our experience demonstrates that safety stand-down initiatives can synergize with ongoing improvement cycles to mitigate adverse trends in hospital harm events.