The relationship of hospital systems and utilization of patient safety practices to patient outcomes

Determining the factors that are associated with the provision of safe patient care is crucial for today's healthcare environment. Such efforts are necessary, as research demonstrates that the majority of medical errors, or adverse events, are preventable. This correlational study provided evidence regarding the types of acute care hospitals that are likely to utilize patient safety practices and whether this composite of patient safety practices is associated with patient safety outcomes.; The Quality Health Outcomes Model and Learning Organization Theory guided hypothesis development. Secondary data were used to evaluate hospital systems, patient safety practices, and patient outcomes on a stratified probability sample of acute care hospitals. JCAHO accreditation performance areas were reduced into sub-component scores to measure the utilization of patient safety practices. Patient safety outcome rates were calculated using the AHRQ Patient Safety Indicator software; hypotheses were tested using multiple regression analysis.; Findings indicate that acute care hospitals with higher levels of nurse staffing were more likely to utilize patient safety practices, as measured by the broader overall JCAHO score, than hospitals with poorer levels of nurse staffing. When the overall performance areas were reduced into sub-component scores, nurse staffing was not consistently associated with the utilization of patient safety practices. Although teaching status and nurse staffing did not affect patient safety outcomes, larger hospitals had higher rates of 'infections due to medical care' than smaller hospitals. Although not hypothesized a priori, larger hospitals also demonstrated higher rates of 'post-operative respiratory failure' than smaller hospitals. Additionally, for-profit hospitals displayed higher rates of 'decubitus ulcer' and 'post-operative respiratory failure' than non-profit and non-federal government hospitals. And finally, the effect of implementing various patient safety practices, and most specifically the resultant impact on patient outcomes, also appears dependent upon the outcome measured. Hospitals utilizing fewer patient safety practices demonstrated higher rates of 'infections due to medical care' and higher rates of 'decubitus ulcers,' but no differences were noted in rates of 'post-operative respiratory failure' or 'failure to rescue.' Some adverse events, such as infection, may be more amenable to the development of policies and procedures designed to prevent occurrence.