St. Jude Children's Research Hospital Uses AHRQ Survey to Promote Patient Safety

St. Jude Children's Research Hospital uses AHRQ's Hospital Survey on Patient Safety Culture to obtain employee feedback on ways to improve medical care and safety for the approximately 8,000 patients who receive care each year. Based on the survey feedback, the Memphis-based hospital launched a hospital-wide initiative in 2017 to improve the handoffs of patient care, starting with inpatient nurses at shift changes.

"AHRQ's Hospital Survey on Patient Safety Culture is an essential tool that we use each year for patient safety assessment and action planning at St. Jude," said James M. Hoffman, Pharm.D., M.S., the hospital's chief patient safety officer.

"The entire survey process opens opportunities to discuss patient safety, and the results help shape our improvement efforts—ultimately improving patient care," he said. "The survey forms a foundation for assessment, staff engagement, and action."

Because patient safety culture occurs mainly at the hospital unit level, St. Jude distributes specific employee survey results to 26 unit-level areas of the hospital. This communication equips supervisors to compare current findings to previous years' results and the hospital’s overall results. Survey data help identify specific employee concerns, and internal focus groups are sometimes held to gather more specific information on ways to improve patient safety.

Based on recent survey feedback, St. Jude prioritized improving patient handoffs and introduced the use of I-PASS.* An evidence-based technique to improve handoffs and transitions of care also supported by AHRQ, I-PASS is a bundle of interventions that improves and standardizes handoffs of patient care during shift changes.

"By using the I-PASS approach, the right information about a patient's current condition is communicated in a structured manner between the incoming and outgoing nurse during a shift change," Hoffman said.

"We're embedding this technique into our practice for handoffs throughout the hospital," he added. "We reinforce the initial training by using trained observers who record how well we follow all elements of the I-PASS mnemonic and give immediate feedback on the handoff."

Each year, more St. Jude employees are participating in the survey and providing feedback. According to Hoffman, "Our survey response rate has increased to nearly 70 percent, from about 62 percent, so we’re getting a broad range of feedback to help direct patient safety improvement opportunities."

Since its release in 2004, AHRQ's Hospital Survey on Patient Safety Culture has been used by hundreds of hospitals in the United States to assess their patient safety culture as viewed by their own employees. Hospitals also voluntarily submit their survey results to a national database, which serves as a central resource so hospitals can compare their safety culture results with those of other hospitals.

Hoffman and his colleagues recently used data from the AHRQ national database to investigate associations between dimensions of patient safety culture and perceived reporting practices of safety events, which was published in the Journal of Patient Safety.

Providing feedback about reported errors was the aspect of patient safety culture most strongly associated with voluntary reporting of errors. "Just as we work to engage staff through the AHRQ safety culture survey, our research using the AHRQ database showed the importance of staff feedback to encourage positive safety behaviors like event reporting," Hoffman noted.

*I-PASS is a mnemonic: I, Illness Severity; P, Patient summary; A, Action items, S, Situation awareness and contingency planning; S, Synthesis by receiver.