Patient Safety Organization (PSO)

What is a PSO?

pso_logo In July 2005, Congress developed the federal Patient Safety and Quality Improvement Act of 2005 (PSQIA) in response to the Institute of Medicine report, To Err Is Human. The Agency for Healthcare Research and Quality (AHRQ) oversees the Patient Safety Rule.

The Patient Safety Act and the Patient Safety Rule provide a structure for PSOs while the legislation provides confidentiality and privilege protections (inability to introduce the protected information in a legal proceeding), when certain requirements are met. The program intentionally differentiates PSO work from most regulatory and mandatory reporting programs.

Check out the most commonly used PSO acronyms.

Still want to know more about PSOs, click here.

How do PSOs improve safety

PSOs support the collection, analysis, sharing and learning from incidents, near misses and unsafe conditions in through the use of Common Formats for uniform reporting of patient safety events. The information collected helps to determine what medical errors are occurring and why in order to prevent them from occurring again.

PSOs aggregate data from many providers to identify risk patterns of care and system failure
PSOs allow providers to work together in a confidential, protected space
PSOs do not impose fines or other punitive results for participating – PSOs are not a regulatory body
PSOs assure participating providers their safety work will not be used against them

Who can participate with a PSO

Any licensed provider can participate with a PSO and receive the protections, including but not limited to, emergency medical services (EMS), nursing homes, home health and hospice, pharmacies, hospitals, health systems, medical offices, and ambulatory surgery centers (ASC).

Why join a PSO

Protecting. A PSO offers a way for licensed healthcare providers to receive federal confidentiality and privilege protections of the federal Patient Safety and Quality Improvement Act of 2005.
Learning. Working with a (PSO) offers learning & educational opportunities.
Preventing. A PSO can recommend proactive measures from lessons learned to assist in the prevention of future adverse events.

Additional Resources:

Stars Blue

“Our small community hospital did not have an electronic event reporting system, but participation in the Center’s PSO and Verge Health has met that need. We recently started using the front line icons, which means our staff now begin the reports right from our intranet – an inexpensive alternative for easy event reporting! Working with CPS has been so easy and rewarding. The availability of their staff for questions and consultations is always just a phone call away. We are certainly a safer place for patient care by working with them.”

– JULIE JONES, COMMUNITY HOSPITAL-FAIRFAX

BLOG:

PSO Case Law: Ungurian v. Beyzman, et al., 2020 PA Super 105:

A recent Pennsylvania case shows how courts narrowly interpret the PSQIA, ignoring the D & A pathway and the clear language of the Final Rule. (Ungurian v. Beyzman, et al., 2020 PA Super 105). The cour

Joint Commission New Sentinel Event Alert 61: Managing the Risks of Direct Oral Anticoagulants:

The Center for Patient Safety wants to share this important harm-prevention advice from The Joint Commission and its Sentinel Event Alert: Managing the Risks of Direct Oral Anticoagulants. The Joint Commis

CPS Safety Watch/Alert – Culture Can Improve the Control of Multi-Drug Resistant Organisms:

Issue: A number of events reported co CPS’ Patient Safety Organization (PSO) demonstrate poor handoff communication about the patients’ infectious disease status Examples include: Patient with

RESOURCES:

The Center for Patient Safety believes that collaboration and sharing are the best ways to drive improvement. We strive to provide the right solutions and resources to improve healthcare safety and quality.