The ‘SAFE’ initiative – An innovative approach to safer patient care in a tertiary hospital setting
Notice bibliographique
Résumé
Introduction: Out of hours inpatient care within Australia, defined as the hours outside of 0800 to 1600 hours Monday to Friday, is traditionally provided by on-call medical teams, working in silos, supported by onsite junior medical staff. This model can be associated with poor communication both between and within teams, lack of accountability, failure of escalation, and a reactive model of care. International literature reveals that the outcomes of patients admitted to hospital out of hours are poorer, resulting in a discrepancy in mortality between in and out of hours admissions.Methods: We aimed to reduce the discrepancy in mortality between in and out of hours admissions, as well as reducing overall inpatient mortality. Using a resilience engineering approach, we introduced a novel model of out of hours care - the ‘Safety After Hours for Everyone’ (SAFE) Team. This incorporated a departmental model, with clear and robust internal leadership, external accountability, and formal processes for identification, review and follow up of at risk patients, as well as protocolised escalation processes.Results: The introduction of the SAFE model has been associated with a continuous reduction in the overall Hospital Standardised Mortality Ratio (HSMR) from 0.71 to 0.54 (periods January to March 2015 vs January to March 2018. In addition, the SAFE model has been associated with a reduction in out of hours mortality (defined as admissions from 1600 to 0800) from 0.98 to 0.38 (periods January to March 2015 vs January to March 2018). This has been accompanied by a qualitative improvement in the quality of care delivered out of hours, and improved satisfaction with working conditions and training delivered out of hours. Due to a drastic reduction in unplanned Resident Medical Officer (RMO) overtime associated with the introduction of the model, implementation was near cost neutral.Conclusion: The introduction of the SAFE model has been associated with improved hospital outcomes, in conjunction with improved medical and nursing staff experiences, at a low marginal cost. This model has scope to be applied to similar tertiary level hospitals, or modified to fit within most hospital structures. A key component to the success of this model’s innovation, is acknowledgement of the importance of after hours care provision to patients, highlighted by the formation of a department of after hours medicine as part of the SAFE model.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».