The effect of a transforming care initiative on patient outcomes in acute surgical units: a time series study

Abstract

AIM: To examine the relationship between the implementation of a transforming care initiative and two patient outcomes, inpatient falls and hospital acquired pressure ulcers. BACKGROUND: Patients continue to experience harm in hospitals from adverse events such as inpatient falls and hospital acquired pressure ulcers. These and other patient safety concerns led to transforming care initiatives. DESIGN: This cohort study used historical controls and a time series design. The setting was two surgical units of an acute care hospital; 7125 patients discharged from these units between July 2008-December 2010 were included. Those patients discharged during the initial 3 months of implementation were excluded. Several interventions were adopted as part of the transforming care initiative such as bedside handover and bedside whiteboards. Coded administrative data were accessed to identify patients who had experienced a fall or acquired a pressure ulcer during their hospital stay. Statistical process control was used to identify changes in outcomes over time. RESULTS: The findings demonstrated variation in the proportion of patients experiencing a fall in both units and for the proportion of patients acquiring a pressure ulcer in one unit, following implementation. CONCLUSION: These results demonstrate that implementing a transforming care initiative may have some influence on the quality and safety of patient care as measured by patient falls and pressure ulcers but findings varied. Further research is required to gain an understanding of the inconsistency of the impact of these initiatives across all clinical contexts.