The effect of external inspections on safety in acute hospitals in the National Health Service in England: A controlled interrupted time-series analysis

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.