Implementation of a standardized tool for root cause analysis selection. November 20, 2024

https://psnet.ahrq.gov/issue/implementation-standardized-tool-root-cause-analysis-selection Implementation of a standardized tool for root cause analysis selection. Wahlstedt E, Levy BE, Scott E, et al. J Patient Saf. 2024;Epub Oct 18. The root cause analysis or RCA2 framework is a standardized approach to identify patient safety incidents based on their potential harm and frequency. In this study, researchers used an RCA2 algorithm to identify high-risk events for root cause analysis. Among 104 cases identified from the VA health system, the algorithm recommended nearly 57% for RCA. In comparison, only 17% of cases met the current institutional selection process, missing 45 potential high-frequency, high-harm events.