In the landmark 1999 publication To Err Is Human, the Institute of Medicine documented the problem of patient harm in US hospitals. They estimated up to 98,000 deaths per year in US hospitals were due to medical errors. Since then, there has been little progress in reducing serious harm events. Recently, best practices from other industries known for high reliability have been adapted for use in health care. A daily meeting to review operations and safety concerns, a routine practice in the nuclear power industry, is one such strategy.
The Daily Safety Check In (DSCI) serves as a forum for the promotion of safety throughout the organization. Unit and service leaders report safety events from the last 24 hours, current concerns about the ability to fulfill their responsibilities safely and any anticipated needs to maintain a safe environment. Senior leaders acquire situational awareness of safety and quality issues which enables them to assign responsibility for corrective actions and prioritize efforts. All participants are encouraged to speak up, cross check each other and review specific safety behaviors or error prevention tools that may be applicable to the challenges of the day.
The DSCI is held daily at 9:05AM. The meeting is moderated by a senior executive who begins by announcing the “Days Since Last Serious Safety Event (SSE)”. The census is reviewed to identify areas with high patient volume. The Chief Medical Officer describes new safety initiatives and resolutions for past issues. The admitting hospitalist reports safety concerns including known clinical errors. Each nursing unit and ancillary service then relates all past events, current concerns and anticipated needs. Infection Control reports hospital acquired infections by nursing unit. The group brainstorms mitigation strategies for safety concerns and assigns accountability for problems that cannot be immediately rectified.
Since beginning the DSCI, the number of incident reports has increased by about 50%. Initially the increased reporting was associated with increased identification of SSEs. The interval between events averaged 12 days at baseline. In the 5 months after implementation of DSCI, events decreased and the “Days Since Last Serious Safety Event” tally reached 44. The rolling 12 month average rate of SSEs per 10,000 patient days is now declining.
The DSCI has increased awareness of safety throughout the institution. Staff have become more cognizant of errors as evidenced by increased incident reporting. Over time, daily involvement of senior leadership with DSCI participants appears to be successful in reducing errors resulting in serious patient harm.