Rapid-Cycle Improvement During the COVID-19 Pandemic: Using Safety Reports to Inform Incident Command

Abstract Background and Objective Hospital incident command (IC) systems facilitate emergency preparedness and response and are currently being used nationally during the COVID-19 pandemic. Electronic safety reporting systems provide real-time awareness from frontline staff on critical emerging patient safety issues. During an IC, some of the traditional structures for patient safety and risk identifying, investigating and escalating safety events change. We sought to develop an approach for integrating real-time patient safety event notification and response within our COVID- 19 IC structure. Methods A report was designed to curate daily COVID-19 related safety reports (SRs) and a team consisting of IC leadership, patient safety and risk management was assembled. A new process for identification, notification, escalation, communication and resolution of COVID-19 related SRs was developed and iterated through virtual huddles and emails. This process was deployed within a one-week period and tested over a three-week period. Results From 3/10/2020 to 4/10/2020, we identified 310 COVID-19 related safety reports, ranging from one to thirty per day. Key themes identified: 22.6% potential exposures to COVID-positive employees or patients, 22.3% about PPE, and 20.0% on screening procedures. Events were examined for the presence of potential systems problems and when discovered, systems improvements were implemented locally and systematically. Conclusion A simple, virtual safety reporting process can identify real-time patient safety risks pertaining to COVID-19 and drive local and system-level improvement efforts through IC, during times of crisis. This model of a modified safety reporting and resolution through IC can be applied to other health systems and emergencies.