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The Relationship Between Hospital Systems Load and Patient Harm

Pedroja, Alberta T. PhD, CPHQ*; Blegen, Mary A. PhD, RN, FAAN; Abravanel, Rebecca PhD; Stromberg, Arnold J. PhD§; Spurlock, Bruce MD#

doi: 10.1097/PTS.0b013e31829e4f82
Original Articles

Objectives The objective of this study was to describe the relationship between patient harm due to health-care errors and the stresses on the hospital systems that occur because of the patients in need of care.

Methods Two California hospitals each provided 1 year of data to study the relationship between patient harm and Hospital Systems Load. This observational study used 2 metrics, Hospital Systems Load and patient harm. Hospital Systems Load was a composite measure consisting of the areas in the hospital most sensitive to intensity of service developed using factor analysis and clinical judgment to select the components. Patient harm was assessed using a weighted measure of all hospital incidents occurring during a single day and another controlling for census. Analyses were performed separately for each hospital, and each was broken up into weekdays and weekends. These 8 conditions were compared using a Pearson’s r and a trend analysis.

Results Patient harm trended upward as the Hospital Systems Load increased. Six of the 8 analyses were statistically significant.

Conclusions The results of this analysis are highly suggestive of a relationship between Hospital Systems Load and patient harm.

From the *ATP Healthcare Services, LLC Northridge; †Emerita Community Health Systems, School of Nursing University of California San Francisco San Francisco; ‡BEACON The Bay Area Patient Safety Collaborative Roseville, California; §Department of Statistics University of Kentucky Lexington, Kentucky; and #Cynosure Health, Roseville, California.

Correspondence: Alberta T. Pedroja, PhD, 8624 Louise Avenue Northridge, CA 91325 (e-mail:

The authors disclose no conflict of interest.

Funding for this project was provided by the Gordon and Betty Moore Foundation.

Appreciation also goes to the hospital members of the Bay Area Patient Safety collaborative.

© 2014 by Lippincott Williams & Wilkins