Patient safety tools used in regional slovak hospitals
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Trnava University in Trnava, Slovakia FACULTY OF HEALTH SCIENCES AND SOCIAL WORK DEPARTMENT OF PUBLIC HEALTH. PATIENT SAFETY TOOLS USED IN REGIONAL SLOVAK HOSPITALS . prof Viera Rusnáková , MD, PhD , MBA Katarína Naďová , MD. 25 .04.2014. BACKROUND.

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Patient safety tools used in regional slovak hospitals

Trnava Universityin Trnava, Slovakia

FACULTY OF HEALTH SCIENCES AND SOCIAL WORK

DEPARTMENT OF PUBLIC HEALTH

PATIENT SAFETY TOOLS USED IN REGIONAL SLOVAK HOSPITALS

prof Viera Rusnáková, MD, PhD, MBA

Katarína Naďová, MD

25.04.2014


Backround
BACKROUND

  • Improving quality and safety of healthcare is frequently declared objective of all stakeholders in any health care system

  • Patient safety has become natural part of evaluation of hospital performance indicators, which represent a challenge for creation of health policies and initiatives in European countries (e.g. OECD)

  • Patient safety effort links new technologies, management tools (safety audits), as well as appropriate evaluation of culture in health care organizations, however

  • Multi professional cooperation and education is needed for achieving progress in PS

  • Decentralized approach is possible if country/national level initiatives are not sufficient


Objectives
OBJECTIVES

The aim of the contribution is to emphasize

the issue of patient safety (PS) in hospitals and

to demonstrate initiatives of hospitals within the Trnava Region in collaboration

with the Faculty of HS and SW TU

Results from patient safety culture (PSC) survey, evaluation of selected PATH - EU indicators and utilization of PS audit as proposed by the WHO

willbepresented.


Trnava county
Trnava County



Patient safety culture survey
Patient safety culture survey

  • The survey was conducted in three hospitals in Trnava Region using

    AHRQ questionnaire "The hospital survey on patient safety culture”.

  • The target population was created by 1,787 health workers from all hospital departments. RR was 75% (1,341 respondents).

    36 questionnaires were excluded during evaluation (based on not relevant / negative responses).

  • Statistical data processing:

    • Basic descriptive statistics

    • correlations mixed model linear regression, chi-square test and paired proportional test at significance level of p ≤ 0.05.

    • Cronbach's alpha test was used to analyze the compatibility of the respondents' answers and to verify the validity of the questionnaire used Slovak version


Assessment of quality safety indicators
Assessment of quality/safety indicators

  • Search for available indicators from WHO PATH- EU project set was conducted in tree hospitals and suitable data from patients electronic health records in one hospital database MEDEAwere collected

  • Retrospective data for the period 2009 to 2011 were analyzed from one hospital

  • Statistical data processing:

    • basic descriptive statistics and stratification

    • Kolmogorov-Smirnov and Shapiro-Wilk test, a simple independent t - test, linear regression and Pearson correlation (p ≤ 0.05)

    • boxplots, cumulative graphs

      For statistical analysis of the data was used in the work program SPSS 13.0 and R-project 2.3.7.1.


Analyzed path indicators
Analyzed PATH indicators

  • C – section rate

  • Length of stay and

  • Patient based 30 days mortality in-hospital

    • Inguinal hernia: ICD-10: K40

    • Stroke: ICD-10: I61, I62, I63, I64

    • Acute Myocardial Infarction (AMI): ICD-10: I21, I22

    • Community acquired pneumonia: ICD-10: J15, J18

      (J13, J14,A48.1 were not occurred)


Patient safety audit
Patient safety audit

  • WHO PS audit for adverse events was piloted in two hospitals at departmental level

    • Neurology - 100 patient records and

    • Urology – 50 patient records assessed

    • February- March 2013

    • In collaboration with PH students and hospital epidemiologist

  • Reporting system for hospital acquired infection was analyzed in parallel


Results i

Patient safety culture survey

Interview AHRQ

Results I.


12 dimensions ahrq psc in slovak hospitals 2011 comparison with the usa survey 2009
12 dimensions AHRQ PSC in Slovak Hospitals (2011) -- Comparison with the USA survey (2009)

Data are in %

*P-value ≤ 0.05

** P-value ≤ 0.01

*** P-value ≤ 0.001


Comparison of views mds and nurses 12 dimensions of safety culture questionnaire ahrq
Comparison of views MDs and nurses - 12 dimensions of safety culture questionnaire AHRQ


Reporting system number of events that were reported in the last 12 months international comparison
Reporting system Number of events that were reported in the last 12 months – international comparison

Data are in %



Los and 30 days mortality for selected diagnosis
LOS and 30 days mortality for selected diagnosis

* P ≤ 0.05, ** p ≤ 0.01. *** P ≤ 0.001 ( independent sample t - test)


Results iii
Results III.

Incidence of adverse events was

  • 9% (CI 95% 4 - 16%) atneurologydept. eventually

  • 4% (CI 95% 0,64 – 11,91%) aturology dept.

    from restricted sample (100 eventually 53) of medical records audited.

    Adverse events were connected with longer LOS (p<0,001) and in 50 % were preventable,

    but several limitations of retrospective methods was revealed.


Summary
SUMMARY

Despite limitations of presented studies it is evident that:

  • Analysis of selected indicators demonstrated

    • No significant differences in the quality of provision of health care in general but

    • insufficient quality of data for routine analysis

  • Problems are in culture of patient safety

    • The issue is reporting systems and mutual communication, non punitive response to adverse events, role of management


Summary cont
SUMMARYcont.

  • Challenges for hospital managements are in

    • Use of guidelines and tools for assessing risk patients

    • Definition of responsibility for quality and safety especially for HAI

    • Improving HIS and meaningful use of HER for performance assessment

  • Academy could play significant role in the improvement of

    • Education and training of hospital staff

    • Providing capacities for research

    • Common conferences and campaigns – egg Hand hygiene, Surgical check list,…

    • Culture change support – increase maturity especially in patient safety culture


Conclusion ultimate change is needed
CONCLUSION – ULTIMATE CHANGE IS NEEDED

Information is actively searched

Reporting persons are trained

Competences are set up

Errors are analyzed systematically

New ideas are welcome

Information is confidential and unused

Providers of information are punished

Nobody accepts responsibility

Errors are not explained

New ideas are repressed


"Our effort is not about trying

to shame or blame,

it's about improving health care”

(Canadian Patient Safety Institute, 2012).


THANK YOU

FOR YOUR ATTENTION


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