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A SSESSING P ATIENT S AFETY T HROUGH A DMINISTRATIVE D ATA A DAPTING AND I MPROVING E XISTING S YSTEMS. “THE NORDIC PATIENT SAFETY GROUP”. Leifur Bardarson MD, Chief Medical Doctor Department of Quality Assurance Landspitali – University Hospital Reykjavik ICELAND.

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ASSESSING PATIENT SAFETY THROUGH

ADMINISTRATIVE DATA

ADAPTING AND IMPROVING EXISTING SYSTEMS

“THE NORDIC PATIENT SAFETY GROUP”

Leifur Bardarson MD, Chief Medical Doctor

Department of Quality Assurance

Landspitali – University Hospital

Reykjavik

ICELAND

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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Nordic Council of Ministers

2000 – 2003

WORKING GROUP ON QUALITY MEASUREMENTS IN HEALTH CARE

QUALITY INDICATORS

QUALITY DECLARATION


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Nordic Council of Ministers

2004 – 2006

WORKING GROUP ON QUALITY INDICATORS IN HEALTH CARE

Charman: Jens Gøttrik, Chief Medical Officer, Danmark

GENERIC AND SPECIFIC INDICATORS

MENTAL HEALTH

PRIMARY CARE

PREVENTIVE MEASURES

PATIENT PERSPECTIVE

PATIENT SAFETY


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THERE ARE HUNDREDS OF WELL DEFINED INDICATORS

THE INDICATOR JOURNEY OF THE GROUP

THE INDICATOR BUFFET

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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THE INDICATOR JOURNEY OF THE GROUP

THE INDICATOR BUFFET

OECD

AHRQ

Norway

WHO

Denmark

Sweden

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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THE INDICATOR JOURNEY OF THE GROUP

DID THEY TASTE GOOD ?

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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EXAMPLES OF “DISHES” ON THE INDICATOR BUFFET TABLE

INDICATORS FROM OECD

  • Postoperative pulmonary embolism or deep vein thrombosis

  • Post op sepsis

  • Obstetric trauma vaginal

  • Postoperative hipfracture

  • Decubitus ulcers

  • Wrong site surgery

  • Complications af aneasthesia

    OTHER INDICATORS

  • Hospital infections

  • Foreign body left during procedure

  • Safety culture

  • Reoperations

  • Prescription and distribution of pharmaceuticals

  • Death in Low-mortality DRGs

  • Interactions af pharmaceuticals

  • Patient safety surveys

  • Audit of medical records

  • Readmissions

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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Jes Søgaard 1982

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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THE GROUPS PRESENT MENU

  • OECD INDICATORS

  • STANDARDISED IN-HOSPITAL MORTALITY

  • IHI´s TRIGGER TOOLS

  • SAFETY CULTURE (AHRQ)

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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SAFETY CULTURE

Shared values (what is important) and

beliefs (how things work) that interact

with an organisation’s structure and

control systems to produce behavioural

norms (the way we do things around here).

(James Reason 2006)

UNSPOKEN NORMS

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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1/11.000.000

1/250.000

SAFETY CULTURE

Western airline

Airline from former eastern Europe

Probability of fatal outcome

DIFFERENCE = CULTURE

Health Care

1/1.000

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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PATIENT SAFETY CULTURE

AHRQ

HSPSCHospital Survey on Patient Safety Culture

Indicator ?: Evaluation of patient safety culture

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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Postoperative pulmonary embolism or deep vein thrombosis

OECD INDICATOR PS 07 - AHRQ PSI 12

Definition: Cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) per 100.000 population

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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“NEW” INDICATOR

PS 07,1

Postoperative pulmonary embolism or deep vein thrombosis

after knee or hip replacement

Definition: Cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) per 100.000 population. Operational procedures: Knee and hip replacements.

*) Richard FO, et al.The prevalence of venous thromboembolism after hip and knee replacement surgery. Medical Journal of Australia 2005; 182: 154-160.

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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Post op sepsis

OECD INDICATOR PS 08- AHRQ PSI 12

Definition: Cases of sepsis per 100.000 population with an operating room procedures

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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“NEW” INDICATOR

PS 08,1 Post op sepsis after knee or hip replacements

Definition: Cases of sepsis per 100.000 population with an operating room procedures

*) Nasser S. The incidence of sepsis after total hip replacemant arthroplasty. Seminars in Arthroplasrty 1994; 5:153-159.

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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“NEW” INDICATOR

PS 08,2 Post op sepsis after Bowel surgery

Definition: Cases of sepsis per 100.000 population with an operating room procedures

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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Obstetric trauma vaginal

OECD INDICATOR PS 17

Definition: Percentage (%) of vaginal lacerations (3rd or 4th degree lacerations) of vaginal deliveries

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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Obstetric trauma vaginal

OECD INDICATOR PS 17

How to present this data to users

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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Foreign body left during procedure

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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SUMMARY

  • There exist many scientifically validated patient safety indicators

  • We have experienced inadequate documentation in our administrative datasystems We have to live with that

  • By fragmenting indicators it is maybe possible verify if existing administrative data are reflecting the real world

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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SAFETY CAN BE LOOKED AT FROM MANY DIFFERENT ASPECTS

Leifur Bardarson MD Landspitali - University Hospital ICELAND


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