What Do We Know About Financial Returns on Investments in Patient Safety? A Literature Review

Background: A framework was proposed for making a business case for patient safety interventions and to evaluate whether and how thoroughly financial aspects of investments and returns have been reported. Methods: MEDLINE was searched from inception through January 21, 2005. Articles were selected if they reported on a patient safety intervention or a patient safety related outcome within the United States and indicated that a financial or economic analysis of the intervention was an objective. Results: For 165 articles, a financial or economic analysis was indicated as an objective; 36.4% used original data, 28.5% used referenced data, and 35.2% provided no analysis. Only 13 articles (7.9%) included original data on start-up costs, 45 articles (27.3%) included original data on operating expenses and benefits, and 9 articles (5.5%) provided original financial data on outcomes. Of the 165 articles, 56.4% evaluated technological methods of improving patient safety, such as adoption of computer physician order entry, 20.6% evaluated changes in processes of care, such as staffing changes, and 23% involved other types of interventions or outcomes. Discussion: Few articles provided complete information on the required investment and anticipated return on patient safety interventions. Use of standard financial techniques may strengthen the business case for patient safety interventions.