What Counts? An Ethnographic Study of Infection Data Reported to a Patient Safety Program

Abstract

Context: Performance measures are increasingly widely used in health care and have an important role in quality. However, field studies of what organizations are doing when they collect and report performance measures are rare. An opportunity for such a study was presented by a patient safety program requiring intensive care units (ICUs) in England to submit monthly data on central venous catheter bloodstream infections (CVC-BSIs). Methods:We conducted an ethnographic study involving ∼855 hours of observational fieldwork and 93 interviews in 17 ICUs plus 29 telephone interviews. Findings:Variability was evident within and between ICUs in how they applied inclusion and exclusion criteria for the program, the data collection systems they established, practices in sending blood samples for analysis, microbiological support and laboratory techniques, and procedures for collecting and compiling data on possible infections. Those making decisions about what to report were not making decisions about the same things, nor were they making decisions in the same way. Rather than providing objective and clear criteria, the definitions for classifying infections used were seen as subjective, messy, and admitting the possibility of unfairness. Reported infection rates reflected localized interpretations rather than a standardized dataset across all ICUs. Variability arose not because of wily workers deliberately concealing, obscuring, or

Effective board governance of safe care: a (theoretically underpinned) cross-sectioned examination of the breadth and depth of relationships through national quantitative surveys and in-depth qualitative case studies

“…In addition, further study of the microprocesses associated with board governance is required. 103 Although qualitative and case study research is beginning to emerge in this area, 59,70 further study of the practices undertaken in the boardroom would provide much-needed insight into exactly how patient safety governance is exercised and experienced. Despite growing pressures for boards to improve and emerging evidence that more effective board oversight is associated with higher quality of care, efforts to create effective governance for quality and patient safety are in its early stages.…”

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

“…143 From this perspective, the distortion of indicators occurs not as a deliberate attempt to manipulate the system, but as a result of clinicians attempting to make sense of inherently subjective and messy criteria in the face of uncertainty. 144 Another potential unintended consequence is for clinicians to avoid treating sicker patients to avoid poor publicly reported outcomes. For example, in a news bulletin following the announcement of plans to extend the publication of surgical mortality rates to other specialties, the chairperson of the British Medical Association's Consultants Committee expressed concern that: 145 Some surgeons are deterred from taking on very complex, high-risk procedures because published simplistic league tables count against them.…”

Validation of an Automated Surveillance Approach for Drain-Related Meningitis: A Multicenter Study

“…Previous research has demonstrated important differences among hospitals in methods of HAI surveillance and application of definitions. 11,27,28 Implementation of automated surveillance and, hence, consistent identification of high-risk cases may in the future contribute to more standardized HAI surveillance. 8 Extraction from EHRs was possible for nearly all predictors, although some effort had to be made to standardize data prior to model application and care was taken to ensure the comparability of electronic data sources across hospitals.…”