# Improved quality of recommendations after sentinel event analysis with recommendation improvement matrix training: a before-and-after study at an international patient safety conference

## TL;DR

A study shows that training with the RIM methodology improves the quality of safety recommendations after analyzing critical events in healthcare.

## Contribution

The study demonstrates that RIM training significantly increases the proportion of high-quality recommendations in sentinel event analysis.

## Key findings

- Post-training, 83% of recommendations met quality criteria, a significant increase from 63.3% before training.
- Participants rated the RIM methodology's feasibility and usability highly, with average scores of 4.39/5 and 4.43/5.

## Abstract

To evaluate the effectiveness of the recommendation improvement matrix (RIM) methodology for improving the quality of recommendations resulting from sentinel event analysis, where we hypothesise that the use of the RIM methodology leads to better quality recommendations.

A before-and-after analysis of the quality of the formulated recommendations after sentinel event analysis.

The study was carried out during the 2023 Saudi Patient Safety Centre International Patient Safety Conference.

36 conference participants, including nurses, medical doctors, pharmacists, dentists, general practitioners and quality officers.

RIM methodology training during a structured 3-hour workshop.

The primary outcome was the proportion of recommendations that using the χ2 test, passed the RIM filter criteria before and after training. Secondary outcomes included changes in recommendation categorisation within the matrix and participant ratings of feasibility and usability on a five-point Likert scale using a t-test for comparison.

Prior to training, 49 recommendations were generated, of which 63.3% met the filter criteria. Post-training, the proportion of recommendations passing the filter increased significantly to 83% (p=0.00543). Adjustments to recommendations primarily improved alignment with the filter criteria, though limited improvements were observed in matrix categorisation. Participants rated the methodology’s feasibility and usability highly, with average scores of 4.39/5 and 4.43/5, respectively. However, 46% expressed a need for additional training, particularly on the matrix application.

The RIM methodology significantly improves the quality of recommendations following sentinel event analyses. To enhance its impact, further training focusing on matrix application is necessary. Incorporating the methodology into healthcare education and professional development could strengthen patient safety practices.