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Shojania KG, Duncan BW, McDonald KM, et al., editors. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and Quality (US); 2001 Jul. (Evidence Reports/Technology Assessments, No. 43.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Making Health Care Safer: A Critical Analysis of Patient Safety Practices.

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57Practices Rated by Strength of Evidence

After rating practices on a metric for potential impact, and on the strength of the evidence, we grouped them into 5 categories (Tables 57.1-57.5). These categorizations reflect the current state of the evidence. If a practice that addresses a highly prevalent or severe patient safety target receives a low rating on the impact/evidence scale, it may be because the strength of the evidence base is still weak due to lack of evaluations. As a result the practice is likely to show up at a high level on the research priority scale. However, if the practice has been studied rigorously, and there is clear evidence that its effectiveness is negligible, it is rated at the low ends of both the "strength of the evidence" (on impact/effectiveness) scale and the "research priority" scale.

Table 57.1. Patient Safety Practices with the Greatest Strength of Evidence Regarding their Impact and Effectiveness.

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Table 57.1. Patient Safety Practices with the Greatest Strength of Evidence Regarding their Impact and Effectiveness.

Table 57.2 Patient Safety Practices with High Strength of Evidence Regarding their Impact and Effectiveness.

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Table 57.2 Patient Safety Practices with High Strength of Evidence Regarding their Impact and Effectiveness.

Table 57.3 Patient Safety Practices with Medium Strength of Evidence Regarding their Impact and Effectiveness.

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Table 57.3 Patient Safety Practices with Medium Strength of Evidence Regarding their Impact and Effectiveness.

Table 57.4 Patient Safety Practices with Lower Impact and/or Strength of Evidence.

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Table 57.4 Patient Safety Practices with Lower Impact and/or Strength of Evidence.

57.5 Patient Safety Practices with Lowest Impact and/or Strength of Evidence.

Table

57.5 Patient Safety Practices with Lowest Impact and/or Strength of Evidence.

For each practice listed in Tables 57.1 through 57.5, a designation for the cost and complexity of implementation of the practice is included. The ratings for implementation are "Low," which corresponds to low cost and low complexity (eg, political, technical); "Medium," which signifies low to medium cost and high complexity, or medium to high cost and low complexity; and "High," which reflects medium to high cost and high complexity.

Several practices are not included in the tables because they were not rated. This set of practices have long histories of use outside of medicine, but have not yet received enough evaluations for their potential health care applications:

  • Promoting a Culture of Safety (Chapter 40)
  • Use of Human Factors Principles in Evaluation of Medical Devices (Subchapter 41.1)
  • Refining Performance of Medical Device Alarms (eg, balancing sensitivity and specificity of alarms, ergonomic design) (Subchapter 41.2)
  • Fixed Shifts or Forward Shift Rotations (Chapter 46)
  • Napping Strategies (Chapter 46)

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