A Multisite Assessment of Inpatient Safety Event Rates During the Coronavirus Disease 2019 Pandemic

Abstract

To date, there has been a notable lack of peer-reviewed or publicly available data documenting rates of hospital quality outcomes and patient safety events during the coronavirus disease 2019 pandemic era. The dearth of evidence is perhaps related to the US health care system triaging resources toward patient care and away from reporting and research and also reflects that data used in publicly reported hospital quality rankings and ratings typically lag 2-5 years. At our institution, a learning health system assessment is underway to evaluate how patient safety was affected by the pandemic. Here we share and discuss early findings, noting the limitations of self-reported safety event reporting, and suggest the need for further widespread investigations at other US hospitals. During the 2-year study period from January 1, 2020, through December 31, 2021 across 3 large US academic medical centers at our institution, we documented an overall rate of 25.8 safety events per 1000 inpatient days. The rate of events meeting "harm" criteria was 12.4 per 1000 inpatient days, the rate of nonharm events was 11.1 per 1000 inpatient days, and the fall rate was 2.3 per 1000 inpatient days. This descriptive exploratory analysis suggests that patient safety event rates at our institution did not increase over the course of the pandemic. However, increasing health care worker absences were nonlinearly and strongly associated with patient safety event rates, which raises questions regarding the mechanisms by which patient safety event rates may be affected by staff absences during pandemic peaks.

Keywords: AHRQ, Agency for Healthcare Research and Quality; COVID-19, coronavirus disease 2019; PSI, Patient Safety Indicator.

Figure 1

Smoothed inpatient safety event rate (per 1000 inpatient days and coronavirus disease 2019 [COVID-19] inpatient census) during the COVID-19 pandemic at 3 destination medical centers. A, Dotted lines indicate COVID-19 inpatient census, and solid lines indicate inpatient safety event rates (per 1000 inpatients). B, Event rates stratified by harm (left panel) and nonharm (right panel). C, Event rates stratified by management of care events (MGT, bottom left panel), medication and intravenous events (MED, bottom right panel), laboratory (LAB, center left panel), falls (FALLS, top right panel), and equipment and medical or surgical device and supply related (EQUIP, top left panel). These categories were the most common event types. In this exploratory analysis, we sought to use these graphs to visually assess trends in reported event rates for further, more rigorous statistical evaluations if any clear visual signals emerged.

Figure 1

Smoothed inpatient safety event rate (per 1000 inpatient days and coronavirus disease 2019 [COVID-19] inpatient census) during the COVID-19 pandemic at 3 destination medical centers. A, Dotted lines indicate COVID-19 inpatient census, and solid lines indicate inpatient safety event rates (per 1000 inpatients). B, Event rates stratified by harm (left panel) and nonharm (right panel). C, Event rates stratified by management of care events (MGT, bottom left panel), medication and intravenous events (MED, bottom right panel), laboratory (LAB, center left panel), falls (FALLS, top right panel), and equipment and medical or surgical device and supply related (EQUIP, top left panel). These categories were the most common event types. In this exploratory analysis, we sought to use these graphs to visually assess trends in reported event rates for further, more rigorous statistical evaluations if any clear visual signals emerged.

Figure 1

Smoothed inpatient safety event rate (per 1000 inpatient days and coronavirus disease 2019 [COVID-19] inpatient census) during the COVID-19 pandemic at 3 destination medical centers. A, Dotted lines indicate COVID-19 inpatient census, and solid lines indicate inpatient safety event rates (per 1000 inpatients). B, Event rates stratified by harm (left panel) and nonharm (right panel). C, Event rates stratified by management of care events (MGT, bottom left panel), medication and intravenous events (MED, bottom right panel), laboratory (LAB, center left panel), falls (FALLS, top right panel), and equipment and medical or surgical device and supply related (EQUIP, top left panel). These categories were the most common event types. In this exploratory analysis, we sought to use these graphs to visually assess trends in reported event rates for further, more rigorous statistical evaluations if any clear visual signals emerged.

Figure 2

Unadjusted relationship between 7-day rolling new health care staff absences and inpatient safety event rates including harm and no-harm events of all types (per 1,000 inpatient days) during the coronavirus disease 2019 pandemic at 3 destination medical centers. Shaded region indicates 95% CIs, P<.0001 for the relationship between percentage of health care workers absent and inpatient safety event rates (per 1000 inpatients), and P_interaction<.0001 indicating differences in this relationship by site.