Introducing the patient safety professional: why, what, who, how, and where?

BACKGROUND: Hospital-acquired complications, such as nosocomial infection, falls, and venous thromboembolism, are well known to be frequent and morbid. Unfortunately, prevention remains challenging. Two widely touted prevention strategies-checklists and reminders-have inherent barriers that limit their use as general solutions to these endemic problems. Likewise, relying upon additional vigilance and efforts of those already caring for patients may guarantee that hospital-acquired complications persist, given the time pressures already constraining bedside clinicians. Consequently, we recommend a new type of clinical role in the hospital setting, the "Patient Safety Professional" (PSP), be considered to ensure that each patient receives individualized prevention strategies to minimize the hazards of hospitalization. THE ROLE OF THE PSP: We envision the PSP would be an APRN who would assess assigned patients for hospital-acquired complications following explicit protocols relevant to a short list of safety targets; prioritize identified complications based on morbidity, mortality, and hospital costs; and develop and implement plans to decrease hospital-acquired complications, in consultation with physicians and staff nurses on the unit. We have recently hired such an individual at our hospital and describe-through several vignettes-what our PSP does on a daily basis. EVALUATION OF THE PSP: The rollout, benefits, and costs of PSPs should be carefully evaluated before widespread dissemination is considered. Process measures and clinical outcomes should be monitored. Physician, nurse, and patient satisfaction also need to be assessed.
CONCLUSIONS: Far from replacing the duties of frontline physicians and nurses assigned to care for the patient, we believe that a PSP will strengthen the safety net for hospitalized patients and serve as an expert resource.