Northwestern Memorial Hospital (NMH) has implemented a patient safety program to apply evidence-based practices to keep patients safe from adverse events such as falls, pressure injuries, and errors. This program includes careful attention to improve systems after a near-miss event, and encouragement of staff to speak up when they identify an opportunity for improvement. Patient suggestions provide another source of valuable input into opportunities for safety. One frequently-referenced list of safety events which should often be avoidable is found at this link. (Note: NM data do not include pressure injuries at this time, pending surveillance data system improvements.) These events can often, though not always, be prevented with evidence-based tools and methods. In 2023, the hospital identified 26 such events: Serious Events 2023: Surgical Events – 2; Product or Device Events – 4; Patient Protection Events – 0; Care Management Events – 15; Environmental Events – 5; Radiologic Events – 0; Potential Criminal Events – 0.

Each of these events has a comprehensive action plan which is accountable to senior leaders. For example, learnings from Product events are used to review the products that are selected for patient care and the patient and staff education that accompanies them. Care management events are addressed through improved training, workflow changes, and additional supports to staff. These interventions have produced continuous improvements in safety each year, as measured by improved processes and reduced safety events. NM hospitals also study the experience of other hospitals and health systems to learn from safety events that occur in other places, and also provide confidential, de-identified summaries of safety events to a national protected Patient Safety Organization so that others can learn from our experience.