Comparative economic analyses of patient safety improvement strategies in acute care: a systematic review

Abstract

BackgroundThe objective was to systematically review comparative economic analyses of patient safety improvements in the acute care setting.MethodsA systematic review of 15 patient safety target conditions and six improvement strategies was conducted. The authors searched the published literature through Medline (2000–November 2011) using the following search terms for costs: ‘costs and cost analysis’, ‘cost-effectiveness’, ‘cost’ and ‘financial management, hospital’. The methodological quality of potentially relevant studies was appraised using Cochrane rules of evidence for clinical effectiveness in quality improvement, and standard economic methods.ResultsThe authors screened 2151 abstracts, reviewed 212 potentially eligible studies, and identified five comparative economic analyses that reported a total of seven comparisons based on at least one clinical effectiveness study of adequate methodological quality. Pharmacist-led medication reconciliation to prevent potential adverse drug events dominated (lower costs, better safety) a strategy of no reconciliation. Chlorhexidine for vascular catheter site care to prevent catheter-related bloodstream infections dominated a strategy of povidone-iodine for catheter site care. The Keystone ICU initiative to prevent central line-associated bloodstream infections was economically dominant over usual care. Detecting surgical foreign bodies using standard counting compared with a strategy of no counting had an incremental cost of US$1500 (CAN$1676) for each surgical foreign body detected. Several safety improvement strategies were less economically attractive, such as bar-coded sponges for reducing retained surgical sponges compared with standard surgical counting, and giving erythropoietin to reduce transfusion requirements in critically ill patients to avoid one transfusion-related adverse event.ConclusionsFive comparative economic analyses were found that reported a total of seven comparisons based on at least one effectiveness study of adequate methodological quality. On the basis of these limited studies, pharmacist-led medication reconciliation, the Keystone ICU intervention for central line-associated bloodstream infections, chlorhexidine for vascular catheter site care, and standard surgical sponge counts were economically attractive strategies for improving patient safety. More comparative economic analyses of such strategies are needed.

Role of the anesthesiologist in the wider governance of healthcare and health economics

“…Surveys of the anesthesia, critical care, and perioperative literature reveal that there are very few economic analyses published in our field despite increasing recognition of the need. 19,27,28 It is an opportune time for anesthesiologists and clinical leaders to become familiar with the tools and methodologies of health economics in order to facilitate decision-making. When a drug, device, or procedure comes to market in Canada, there is no guarantee that it represents good value for money compared with the next best alternative.…”

Reducing Hospital Errors: Interventions that Build Safety Culture

“…In addition, as previously established (34,176), our review finds that a rigorous, quantitative demonstration of the relationship between an intervention and outcomes remains rare. Although one could easily dismiss research designs other than randomized clinical trials as less rigorous and call for stronger analytical methods for evaluation, our investigation suggests some caveats to this typical conclusion.…”

“…Our review focuses specifically on hospital errors because this is where the bulk of intervention efforts have been directed and where the measurement of errors is most developed. To distinguish our review from other excellent recent reviews of interventions designed to reduce organizational errors in the health care context (34,176), we focus explicitly on interventions that reduce errors by directly or indirectly impacting safety culture. This allows us to categorize these activities using a theoretical model that shows how interventions may work together to shape safety climate and safety culture in a process that reduces hospital errors over time.…”

Effect of Medication Reconciliation on Unintentional Medication Discrepancies in Acute Hospital Admissions of Elderly Adults: A Multicenter Study

“…When examining strategies to improve medication history taking, electronic medication reconciliation and medication reconciliation (generally defined as the process of obtaining and maintaining a complete and accurate list of the current medication use of an individual across the healthcare settings) performed by pharmacists instead of physicians are effective. Pharmacy‐based medication reconciliation has been shown to be one of four cost‐effective strategies (out of a total of 21) to improve patient safety . When pharmacists perform medication reconciliation in the ED, a recent study including 3,594 medication histories showed that 59% of the medication histories that pharmacists took were different from those that physicians took .…”