Date of Award

2020-05-16

Degree Name

PhD Nursing

Dissertation Committee

Eileen Fry-Bowers, PhD, JD, CPNP, FAAN, Chairperson; Ann M. Mayo, DNSc, RN, FAAN, committee member; Laurie Ecoff, PhD, RN, NEA-BC, committee member

Keywords

Patient Safety, Adverse Events, Medical Error, Vulnerable Populations, Implicit Bias, Harm, Preventable Harm

Abstract

Purpose. This study explored the association between patient sociodemographic characteristics and the occurrence of serious safety events (SSE) in hospitalized patients. Specific aims were to describe among patients who have experienced an SSE: 1) patient sociodemographic variables (age, gender, race, ethnicity and language spoken), health insurance coverage, patient zip code, payer mix, site of care location, and severity of event; 2) the relationships between the select patient sociodemographic variables, health insurance coverage, patient zip code, payer mix, site of care location and SSE level of harm; and 3) what factors increase or decrease the odds of experiencing higher levels of harm or death from an SSE.

Background. Preventable harm and death in health care is a concern for all, but structural barriers and implicit bias inherent in the U.S. health care system may increase the risk of injury and poor outcomes for some populations.

Methods. This study utilized a retrospective, cross-sectional cohort design. Data acquired from a health care system in southern California covering an 8-year period was extracted from the organization’s SSE database and electronic health record.

Findings. There was a statistically significant association between level of harm and hospital location, p = .007, ethnicity, p = .038; and insurance (yes/no), p = .040. Race and language were not found to be significantly associated with those patients who experienced an SSE. Patients were 1.22 times more likely to experience higher levels of harm or death if they were non-Hispanic/non-Latino, 1.88 times more likely to experience higher levels of harm if they did not have insurance, and 11.45 times more likely to experience higher levels of harm if they received care at Site 3.

Implications. The findings of this study increase understanding of patient safety and health care disparities. It provides guidance for future nursing research leveraging racial and ethnic data as a proxy for implicit bias, demonstrates use of voluntary reported events to support administrative patient safety data, and encourages consistent education to healthcare professionals regarding implicit bias. Better understanding how implicit bias can influence nurse’s decision making and critical thinking is important in preventing patient harm.

Document Type

Dissertation: Open Access

Department

Nursing

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