title: Impact of random safety analyses on structure, process and outcome indicators: multicentre study.
abstract: BACKGROUND
  To assess the impact of a real-time random safety tool on structure, process and outcome indicators.
  
  
  METHODS
  Prospective study conducted over a period of 12 months in two adult patient intensive care units. Safety rounds were conducted three days a week ascertaining 37 safety measures (grouped into 10 blocks). In each round, 50% of the patients and 50% of the measures were randomized. The impact of this safety tool was analysed on indicators of structure (safety culture, healthcare protocols), process (improvement proportion related to tool application, IPR) and outcome (mortality, average stay, rate of catheter-related bacteraemias and rate of ventilator-associated pneumonia, VAP).
  
  
  RESULTS
  A total of 1214 patient-days were analysed. Structure indicators: the use of the safety tool was associated with an increase in the safety climate and the creation/modification of healthcare protocols (sedation/analgesia and weaning). Process indicators: Twelve of the 37 measures had an IPR > 10%; six showed a progressive decrease in the IPR over the study period. Nursing workloads and patient severity on the day of analysis were independently associated with a higher IPR in half of the blocks of variables. Outcome indicators: A significant decrease in the rate of VAP was observed.
  
  
  CONCLUSIONS
  The real-time random safety tool improved the care process and adherence to clinical practice guidelines and was associated with an improvement in structure, process and outcome indicators.
authors.affiliation: Intensive Care Unit, Hospital Universitario Joan XXIII, Tarragona, Spain.|Instituto de Investigación Sanitaria Pere Virgili, Rovira i Virgili University, Tarragona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Bodí
authors.affiliation: Intensive Care Unit, Hospital Universitario Joan XXIII, Tarragona, Spain. iban_84@hotmail.com.
authors.forename: Iban
authors.identifier: http://orcid.org/0000-0002-2579-3946
authors.initials: I
authors.lastname: Oliva
authors.affiliation: Intensive Care Unit, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain.
authors.forename: Maria Cruz
authors.initials: MC
authors.lastname: Martín
authors.affiliation: Intensive Care Unit, Hospital Universitario Joan XXIII, Tarragona, Spain.
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Gilavert
authors.affiliation: Intensive Care Unit, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Muñoz
authors.affiliation: Instituto de Investigación Sanitaria Pere Virgili, Rovira i Virgili University, Tarragona, Spain.|Department of Preventive Medicine, Hospital Universitario Joan XXIII, Tarragona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Olona
authors.affiliation: Intensive Care Unit, Hospital Universitario Joan XXIII, Tarragona, Spain.|Instituto de Investigación Sanitaria Pere Virgili, Rovira i Virgili University, Tarragona, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Sirgo
keywords: Critical patients; Intensive care unit; Quality indicators; Real-time safety audits; Safety