Variations in Surgical Outcomes is Associated with Hospital Compliance with Safe Practices
The National Quality Forum (NQF) and Leapfrog are non–profit organizations that advocate a list of 27 “safe practices,” designed to promote safety and prevent possible complications for hospitalized patients.
A recent study by Brooke et al. used 2005 Leapfrog survey data to determine whether hospital compliance with these safe practices affected in–hospital complications, failure to rescue from complications, and all–cause 30–day mortality after six high–risk procedures—esophagectomy, pancreatectomy, hepatectomy, colectomy, gastrectomy, and open abdominal aortic repair.
The study was a cross–sectional analysis of 658 nationwide hospitals that responded to the 2005 Leapfrog survey. Of these 658 hospitals, 273, or 41%, were in full compliance with the safe practices, while 385, or 59%, were in partial compliance.
The study found that the unadjusted rate of complication for patients undergoing any high–risk procedure was greater in hospitals with full compliance to the safe practices than in those with only partial compliance (12.4% vs. 10.9%; p < .05). After adjusting for patient and hospital level covariates, the rate of complication was found to be even greater in hospitals that complied fully with the safe practices than in those that were only partially compliant.
The unadjusted rate of failure to rescue from any complication, however, was lower in hospitals which were in full compliance with the safe practices than in those only in partial compliance (7.8% vs. 9.4%; p < .05). After controlling for patient and hospital covariates, mortality associated with any complication was found to be even less likely in hospitals with full compliance to the safe practices than in hospitals with partial compliance.
In addition, hospitals in full compliance with the safe practices were found to have significantly lower unadjusted mortality rates than hospitals with partial compliance (2.5% vs. 3.1%; p < 0.5).
This study provides new insight into how a hospital’s safe practices and procedures may ultimately play a role in patient outcome. The results reinforce the importance of having systems and procedures in place in hospitals to promote safety in order to prevent possible complications.