Unintended negative consequences

All quality improvement initiatives can have unintended negative consequences and it is important to think about and try and predict such problems before implementation.

For example, the introduction of a pneumonia guideline that aims to speed up the administration of guideline-adherent antibiotics to pneumonia patients may result in an increase in the prescribing of antibiotics for patients with non-infection, acute cardio-respiratory conditions.

The diagnostic accuracy of physicians may decrease due to the imperative to prescribe more quickly.

Likewise, restrictive antibiotic stewardship strategies could increase the door-antibiotic-time for patients with severe infection if the approval process for certain antibiotics is too cumbersome. It is therefore important to consider ‘balancing measures’ such as measurement of the proportion of patients with severe infection who receive antibiotics within 1 hour of admission (or detection) and 30-day mortality.

The issues of negative consequences and balancing measures will be referred to again in Week 3 when we look at measurement.