Improving Safety through a Virtual Learning Collaborative

Abstract

Background: Frontline healthcare safety leaders require expertise and confidence to manage local safety programs effectively yet are confronted with substantial challenges in identifying risk and reducing harm.

Methods: We convened a multidisciplinary safety learning collaborative in a children's hospital pediatric department and used the Institute for Healthcare Improvement's Breakthrough Series model. Participants attended four virtual education sessions over 13 months (September 2020-September 2021) focused on identifying harm and using tools to improve safety. We analyzed departmental safety data monthly throughout the collaborative. The primary outcome was the development of improvement projects using direct application of the session content. The secondary outcome was participant confidence in improving safety via pre- and postsurveys.

Results: Seventy clinicians and quality consultants participated. Fifteen divisional safety improvement projects were initiated. The percentage of survey respondents who reported feeling "completely confident" in their ability to improve safety increased from 26% (n = 39) to 58% (n = 26) from September 2020 to September 2021 (P = 0.01) and maintained at 65% 1 year after the end of the collaborative. We observed a decrease in the mean rate of reported inpatient preventable and possibly preventable moderate/serious/catastrophic events per 1000 bedded days from 1.10 (baseline) to 0.71 (intervention period).

Conclusions: Through a collaborative effort in a virtual learning environment, we facilitated the development of fifteen safety projects, increased leaders' confidence in improving safety, and saw improved inpatient safety. This approach, which involves healthcare professionals from various disciplines, may be effectively adapted to other settings.

Fig. 1.

Improving departmental safety key driver diagram: The development of the key driver diagram allowed us to explore the drivers and potential change strategies to determine the content of our learning session.

Fig. 2.

Learning collaborative timeline and learning session details: The timeline and learning session agendas supported learning collaborative planning and implementation. DoP, Department of Pediatrics; QI, quality improvement.

Fig. 3.

Safety management framework: The development and application of the safety management framework provided a systematic approach to capturing, analyzing, and mitigating threats and events at a local level.

Fig. 4.

Statistical process control charts (u-charts) for inpatient preventable and possibly preventable event rates per 1000 bedded days. A, the rate of inpatient near miss/none/minor preventable and possibly preventable events per 1000 bedded days did not change throughout the intervention. B, the rate of inpatient moderate/serious/catastrophic events preventable and possibly preventable events per 1000 bedded days decreased from a mean rate of 1.10 (baseline period) to 0.71 (throughout the intervention period). UCL, upper control limit; LCL, lower control limit.

Fig. 5.

Statistical process control charts for outpatient preventable and possibly preventable events. A, the u-chart displays the rate of outpatient near miss/none/minor preventable and possibly preventable events per 1000 patient visits, which increased from a mean rate of 2.29–3.02 throughout the intervention period. B, the g-chart displays the median for days between events for outpatient moderate/serious/catastrophic events, which was 20 throughout the intervention period.

Fig. 6.

Statistical process control charts for preventable and possibly preventable emergency medicine events. A, the rate of emergency medicine near miss/none/minor preventable and possibly preventable events per 1000 patient visits decreased from a mean of 9.81 during the baseline period to 8.75 toward the end of the learning sessions and postcollaborative. However, there was a slight increase during the intervention period from March 2020 to March 2021 (mean = 15.19). B, the g-chart displays the median for days between events for emergency medicine moderate/serious/catastrophic events was 31 throughout the intervention period.