The Safety Integration Stakeholders (SAINTS) program to integrate worker and patient safety in Oregon rural hospitals

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PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic accentuated the inextricable link between worker and patient safety. Yet most hospitals have separate initiatives for either patient or worker safety. A case in point is safe patient handling and mobility (SPHM), where most programs are implemented by Employee Health and Safety without coordination with other quality or patient safety departments. This disconnect is significant because adverse and costly outcomes such as patient falls or workers’ patient-assist injuries have overlapping risk factors that must be addressed together. One promising response is through a program that integrates stakeholders, including influential front-line workers, to address overlapping risk factors for patient falls and patient-assist injuries. Our preliminary research pre-tested an integrated safety program at a rural hospital in Oregon that demonstrated 12-month effectiveness in improving leading indicators and reduction of patient-assist injury rates. The program had four main components: 1) the involvement of patient and worker safety stakeholders; 2) the innovative application of Social Network Analysis (SNA) to identify peer-recognized safety leaders instead of self- or supervisor-nominated workers who may not have the influence required to effect change; 3) training stakeholders on safety leadership, and 4) implementation of quality improvement (QI) cycles to reduce safety barriers. Based on these promising results, we plan to build a new scalable intervention to be tested in a rigorous multi-hospital trial. The objective of this proposal is to conduct a cluster randomized controlled trial in six rural hospitals to evaluate the effectiveness and process of a safety program titled Safety Integration Stakeholders (SAINTS). We will test the central hypothesis that relative to usual practice controls, the three hospitals randomly assigned to the SAINTS program will have reduced risk factors for patient falls and patient- assist injuries 12 months after the end of the program. The rationale is that the SAINTS program will positively impact outcomes by identifying and training key players on strategies to boost environmental, administrative, and educational precautions relevant to SPHM. We propose two aims: Aim 1: Determine the SAINTS' effectiveness in reducing overlapping risk factors for patient falls and patient-assist injuries. Effectiveness will be determined by surveying in-patient unit workers on risk factors for patient-assist injuries and patient falls at baseline, six months after program initiation, and 12 months after the end of implementation (primary endpoint). The trial is powered to detect changes in leading indicators, but we will also examine lagging effects on the incidence rates of patient falls, patient-assist injuries, entries in reporting systems, and staff turnover. Aim 2: Identify safety precaution measures produced by the SAINTS program. Given the semi-structured design, we will conduct a multi-method process evaluation to identify the extent to which the program was delivered as planned and if it led to the adoption of preventative measures.