The effect of external inspections on safety in acute hospitals in the National Health Service in England: A controlled interrupted time-series analysis
Date
2019
Type:
Article
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ORCID:
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Abstract
Objectives: To evaluate the effect of Care Quality Commission (CQC) external
inspections of acute trusts on adverse event rates in the English National Health
Service (NHS).
Methods: Interrupted time series analysis including all acute NHS trusts in England
(n=155) using two control groups (new versus historical inspection regime and trusts
not inspected). Multilevel random-coefficients modelling of 1) rates of falls with harm
and 2) pressure ulcers, from April 2012 to June 2016, was undertaken using the new,
resource-intensive regime of CQC inspections as an intervention. Data used in the
model included dates and type of inspection, patient safety indicators, demographic
characteristics and financial risk of hospitals.
Results: In one year, CQC inspected 66 acute trusts (42% of all English trusts) using
their new regime and 46 (30%) using their previous one. Prior to inspections being
announced, rates of falls with harm and pressure ulcers were improving in both
intervention and control hospitals. The announcement of an inspection did not affect
either indicator. After inspections, rates of falls with harm improved more slowly and
pressure ulcers rates no longer improved for trusts inspected using both regimes.
Conclusions: Neither form of external inspection was associated with positive,
clinically significant effects on adverse event rates. Any improvement happening
before the announced CQC inspections slowed after the inspection.
Description
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Citation
Castro-Avila, A, Bloor, K and Thompson, C orcid.org/0000-0002-9369-1204 (2019) The effect of external inspections on safety in acute hospitals in the National Health Service in England: A controlled interrupted time-series analysis. Journal of health services research & policy, 24 (3). pp. 182-190. ISSN 1355-8196
Keywords
Quality of health care, External inspection, Accreditation, Interrupted time series analysis