clinical quality and safety report

CLINICAL QUALITY AND SAFETYREPORT

QUALITY AND CLINICAL SAFETY REPORT

Vision, mission and values

Total Discharged Patients

CUF Oncology Institute

Value-Based Healthcare Programme

CUF Infante Santo Hospital

CUF Torres Vedras Hospital

CUF Porto Hospital

CUF Viseu Hospital

Braga Hospital

Quality Management

Quality policy

Top DRG/Diagnoses and Procedures

Breast Diagnostic and Integrated Treatment Unit

Measurement of Clinical Outcomes

CUF Descobertas Hospital

CUF Santarém Hospital

CUF Cascais Hospital

CUF Coimbra Hospital

Vila Franca de Xira Hospital

Patient Safety

Infection control

National Health Evaluation System (SINAS)

Clinical Quality Indicators

Safety Culture

Infection rates: General indicators

SINAS Third Party Assessment

IAmetrics

Surgical Safety

Falls

Safety in Communication

Legionella: Prevention and Control

SINAS internal monitoring tool

Medication-use safety

Notification system for adverse events

Quality strategy

Clinical Performance

Group-wide Areas CUF Oncology Institute

Value in Healthcare

Unit fact sheets

Glossary

Clinical quality and safety

Structure and Business Activity José de Mello Saúde

01

02

03

04

04

09

11

05

09

11

13

14

15

12

13

14

15

12

13

12

14

15

12

13

03

09

11

06

05

06

07

08

16

18

22

26

24

28

30

17

19

23

27

25

29

31

16

18

22

32

INDEX

QUALITY AND CLINICAL SAFETY REPORT 2019 | 3

FrameworkJosé de Mello Saúde ensures that the healthcare it provides is suitable, effective, safe and evidence-based, and abides by the highest good practice standards.

To strengthen this purpose, José de Mello Saúde has created and is developing its quality and safety programme.

The José de Mello Saúde Quality and Safety Programme describes the process by which it achieves organised, ongoing improvement in the company’s structure, processes and results in order to create value for patients, employees and other stakeholders. This structure supports and continues planning, cultural and leadership activities and professionals’ involvement in the constant quest for quality care and patient safety.

An essential part of this programme and the quality improvement process is defining units of measurement – the indicators – so that we can collect and analyse data and use them to identify opportunities for improvement and establish and develop benchmarks, by comparing figures within and outside José de Mello Saúde’s units.

Consequently, this programme also reflects the effort to integrate quality improvement measures, given that it enables us to achieve our goals of improving healthcare.

ObjectivesThe goals of the Quality and Safety Programme are:

• Support the mission, vision, values and strategic plan of José de Mello Saúde units;

• Build a quality and safety improvement system;

• Satisfy the needs and expectations of patients and other stakeholders, such as family members, companions and the community;

• Develop quality and safety indicators.

PrinciplesThe Quality and Safety Programme is governed by six essential principles:

Patient-focused careQuality improvement at José de Mello Saúde focuses on the patient. The patient comes first in processes and in professionals’ attention. All aspects of patients are respected: physical, psychological, emotional, religious, social, economic and family. José de Mello Saúde’s units exist because of patients and for patients, always with a holistic vision of the person.

Continuous improvementThe José de Mello Saúde units have the structure they need to constantly monitor care and processes and identify needs for improvement using a systematic methodology, problem analysis, promotion of solutions and a guarantee of ingoing results.

Culture of transparency José de Mello Saúde encourages and promotes a culture of transparency based on the disclosure of results achieved and information that enables customers to make an informed choice of therapeutic options.

Transparency is also fuelled by a culture of reporting and accepting mistakes, always with a view to improving the care provided.

Other forms of commitment to transparency are voluntary external evaluation systems such as ISO 9001 certification or international JCI accreditation at José de Mello Saúde’s units.

Involvement of peopleJosé de Mello Saúde encourages everyone in the organisation to take part in its continuous improvement effort whenever possible, based on cooperation and teamwork. Teamwork is essential to the organisation, as it increases commitment, communication and mutual learning, thereby improving our professionals’ work.

Leading by example Support from top management involves a public commitment to quality. It means a positive, motivating attitude support for change, active participation, supply of resources, reviews and follow-ups of progress and recognition of work carried out and results achieved.

1. QUALITY STRATEGY


Value Creation Guided by the principles of Value-based Healthcare (VBH), José de Mello Saúde regards the maxim “measure to improve” as the best way to achieve the best outcomes. It is through these outcomes that we seek the best quality/cost ratio for each pathology and its clinical course, thereby creating greater value for patients. In order to achieve this outcome, we also count on patient information and use PROMs - Patient Reported Outcome Measures and PREMs - Patient Reported Experience Measures.

Vision, mission and valuesThe identity of José de Mello Saúde is characterised by its mission, values and the goals it has set itself.

VisionTo promote the provision of healthcare services with the highest level of knowledge, respecting the primacy of life and the environment, through the development of the organisations’ intellectual capital, in a permanent search for excellence.

MissionTo promote healthcare services delivery with the highest levels of knowledge, respecting the primacy of life and the environment by developing the enterprise’s intellectual capital, constantly searching for the best. To achieve this mission, José de Mello Saúde operates on three platforms of excellence:

Human talent excellence• Transmission and development of the Group's values;

• Evaluating and rewarding performance;

• Attentive and challenging management of the professional career of each employee;

• Fostering a culture of accountability, excellence, rigor and achievement;

• Sharing knowledge and working as a team.

Service excellence• Development of centres of clinical excellence;

• Management of the relationship with customers;

• Humanisation of care;

• Constant improvement in service levels.

Operations and systems excellence• Constantly developing innovation and planning abilities;

• Continuous improvement of processes;

• Systematic increase in productivity;

• Strong investment in clinical and information technologies;

• Strict costs control.

ValuesThe day-to-day management of José de Mello Saúde healthcare units is guided by a standard of behaviour based on the following values:

• Respect for human dignity and well-being

• Human development

• Competence

• Innovation


Information SecurityInformation protection as a support for efficient services delivered to patients, based on integrity, availability of information systems and infrastructure and on data confidentiality.

Eco-efficiencyIdentification of environmental issues arising from healthcare provision, making it possible to assess impacts and prioritise action aimed at minimising and controlling them.

The promotion of sustainable use of natural resources including energy and water, pollution prevention and reduction, reuse and recycling of waste generated.

Occupational health and safetyIdentification of hazards to which professionals are exposed as part of health and safety at work, with a view to risk assessment and prioritisation of actions, ensuring that they are minimised and controlled.

The prevention of injuries, incidents, accidents and occupational diseases.

Legal requirementsCompliance with applicable legal requirements in force and other requirements that may be endorsed.

Continuous improvementThe establishment of a culture of continuous improvement that consolidates the management of processes and promotes the efficiency of the integrated management model.

Quality policyAs a leader in the healthcare sector in Portugal, José de Mello Saúde is committed to the guiding principles of sustainable development.

Respect for these principles means we must ensure that we are creating value at all times so we can satisfy the needs of our patients, employees, shareholders and other entities we work with in the course of our business. Within this framework, José de Mello Saúde uses a model of integrated management that defines:

Healthcare deliveryDelivery of health care in accordance with best practices in the context of technological excellence and proven scientific developments. Prevention, diagnosis and medical treatment of disease, supported by achievement of clinical outcomes that are periodically monitored and reassessed in accordance with the organisation’s goals and objectives.

A sustainable healthcare delivery model in a constant search for ways of meeting patients’ needs.

Patient safetyOur cross-cutting programme for clinical and non-clinical risk management sets out and prioritises ways of identifying and preventing potential risks. This programme is reinforced by implementing the recommendations of good practices in order to eliminate unnecessary damage arising from the provision of health care.


In 2019, José de Mello Saúde maintained its policy of sustainable growth of its business via consolidated expansion of our unit network, thereby reinforcing its benchmark position as a healthcare provider in Portugal. José de Mello Saúde seeks to offer an integrated care service based on a culture of quality, safety and innovation.

José de Mello Saúde operates in an integrated network of healthcare units based on an organisational model grouped into two coordination committees - CUF and PPP.

CUF has been providing private health care since 1945,. It consists of a network of 10 hospitals and nine outpatient clinics in Lisbon, Oeiras, Cascais, Sintra, Mafra, Torres Vedras, Santarém, Matosinhos, Porto, Viseu and Coimbra based on management articulated around the three main CUF hospitals in three geographical clusters - Tejo, Descobertas and Norte.

It focuses on the provision of public health care as part of the National Health Service through management of a public-private partnership of Braga Hospital and Vila Franca de Xira Hospital. The public-private partnership (PPP) management agreement for Braga Hospital ended on 31 August 2019. Until then, the stability of clinical activity and healthcare delivery to the population were maintained, in compliance, as always, with all the obligations set out in the management agreement.

2. JOSÉ DE MELLO SAÚDE STRUCTURE AND BUSINESS ACTIVITY


FundaçãoAmélia de Mello

4%

Farminveste, S.A.

30%

José de Mello,Capital S.A.

66%

3.4 MILLION

1.3 MILLION

455 THOUSAND

2.7 MILLION

7,763

55 THOUSAND

0.50 0.77

509 THOUSAND

651 THOUSAND

0.89

1.3 MILLION

27THOUSAND

CALLSANSWERED AT THE CONTACT CENTRE

CUSTOMERS

APPOINTMENTSTHROUGH THE MYCUF APP

CONSULTATIONS

BIRTHS

RADIOTHERAPYSESSIONS

RARI(RISK-ADJUSTED READMISSION INDEX)

RARI(RISK-ADJUSTED READMISSION INDEX)

MYCUF APPACCOUNTS

EMERGENCIES

RAMI(RISK-ADJUSTED MORTALITY INDEX)

IMAGINGTESTS

RADIOTHERAPYSESSIONS

JOSÉ DE MELLO SAÚDE IN FIGURESEMPLOYEES INPATIENT BEDSHEALTH UNITS

OPERATING THEATRES CONSULTATION ROOMS SURGERIES

6,615 91919

75 1,160 83,000

OPERATING INCOME

EBITDAEBITDA

CONSOLIDATEDINVESTMENT

€701.5M €97.9M €118.5M

A YEARIN NUMBERS

JOSÉ DE MELLO SAÚDE


OPERATING INCOME

€701.5 M

EBITDA

€97.9 M

INVESTMENT IN R&D+I

€2.2 M

HOURS OF TRAINING

60,110DOCTORS IN MEDICAL INTERNSHIP

97ENERGY INTENSITY

304.2 kWh

NUMBER OF VOLUNTEERS

189

2019

2019

2019

2019

701.5

2.4

50,356

97.9

97

304.2

6,615

24 162

1,293

60,110

693

4,764

53.6

111

374 559

5,322

18 427

2,460

9

29.0

2018

2018

2018

20182017

2017

2017

2017

683.1

3.7

52,259

637.4

1.7

50,185

71.2

681

282.9

8,919

29 964

1,880

125,079

941

1,517

72.0

485

45*

8,058

22 873

1,683

133,314

1,252

1,205

31.2

127

371 196

7,039

25 834

2,335

14.03

42.6

97

363 927

6,375

25 838

1,797

16.54

15.622.8

Operating Income

Investment in R&D+I (EUR million)

Electricity Consumption (mhw)

HR Indicators

EBITDA

Medical internships at CUF (no. doctors)

Energy Intensity (kwh/m2)

No. of Employees

Natural Gas Consumption (mhw)

Men

No. of Hours of Training

Hazardous waste accumulated (ton)

No. of Departures

EBIT

Clinical trials at CUF (no. trials)

* In 2017 the energy intensity was presented in Kgep/m2

Water Consumption (m3)

Women

Training indicators

GHG emissions — Scope 1 and 2 (tCO2eq)

No. of Hires

Average hours per employee

Net Income

FINANCIAL CAPITAL (M€)

INTELLECTUAL CAPITAL

NATURAL CAPITAL

HUMAN CAPITAL

2019

130,000 €

189

20182017

185,050 €286,746 €

16365

Donations

No. of Volunteers

SOCIAL CAPITAL

Main indicators 2019


José de Mello Saúde’s units offer a broad range of surgical and medical healthcare provision. This range comes not only from the CUF units but also public-private partnership units. Its overall business activity consists of the following medical specialisms and discharged patients.

Our clinical performance can also be assessed on the basis of diagnosis-related groups (DRGs) as a result of clinical coding. Clinical coding in our private facilities reflects discharged inpatients and patients who have undergone outpatient surgery. It forms the basis for management of clinical information and data used for monitoring, managing and controlling quality, efficiency and process indicators. In the privately managed public units coding covers hospitalisations, outpatient surgeries and outpatient consultations and is also the basis for funding and clinical management.

Homogeneous diagnostic groups constitute a classification system used for inpatients, grouping them into similar, clinically coherent clusters from the point of view of consumption of resources. The information on each hospitalisation and outpatient event is ICD-10-CM/PCS coded and then divided into diagnosis-related groups. This makes it possible to obtain an analytical overview of the hospital’s production and each unit’s clinical complexity. The data presented are related to CUF and Hospital Vila Franca de Xira units. For structural reasons it was not possible to group the data referring to Hospital de Braga.

3. CLINICAL PERFORMANCE

12555

2920

1902

4071

2534

5056

3013

2476

2543

1738

Main Homogeneous Diagnostic Groups (DRGs)

73 Eye procedures, not including sockets

313 Knee and/or leg procedures, not including feet

228 Procedures for inguinal, femoral and/or umbilical hernia

468 Other diagnoses, signs and/or symptoms in the kidney and/or urinary tract

97 Procedures on the tonsils and adenoids

640 Newborn, weight at birth > 2,499 g, normal or with other problems

540 Delivery by caesarean section

560 Vaginal childbirth

98 Other procedures on the ear, nose, mouth and/or throat

315 Procedures on the shoulder, arm and/or forearm

Code TotalDescription

Orthopaedics

Internal Medicin

e

Gynaeco

logy Obste

trics

General Surgery

Urology

Paediatric

s

Otorhinolaryngology

Neurosurgery

Cardiology

Plastic S

urgery

Vascular S

urgery

Others

Medical O

ncology

Psychiat

ry

Ophthalmology

Pulmonology

Paediatric

Surgery

Neurology

Gastroenterology

Maxillofacia

l Surgery

Cardiac Surgery

Thoracic Surgery

Nephrology

11824 1172411395

10777

6805

5528 5453

3556

2183

1401 1376 1296 998 835 756 701 593 565 516 298 158 155 130


3976

1407

1024

1288

2697

1874

1228

1412

2972

3028

1719

1876

1150

1412

1323

1477

975

1031

Main diagnoses (ICD-10-CM)

Main procedures (ICD-10-PCS)

H269 Unspecified cataract

H259

Deviated nasal septum

K4090

0CTPXZZ

Gallstones with chronic cholecystitis without obstruction

Resection of Tonsils, External Approach

Z3800

0CTQXZZ

08RJ3JZ / 08RK3JZ

085E3ZZ / 085F3ZZ

3894 + 3697

1709 + 1626

Single liveborn infant, delivered vaginally

Resection of Adenoids, External Approach

Replacement of Right/Left Lens with Synthetic Substitute, Percutaneous Approach

Destruction of Right/Left Retina, Percutaneous Approach

E11311

0W8NXZZ

Polyp of corpus uteri

Division of Female Perineum, External Approach

Z3801

10D00Z1

10E0XZZ

Single liveborn infant, delivered by caesarean

Extraction of Conception Products, Low Cervical, Open Approach

Delivery of Products of Conception, External Approach

Unspecified age-related cataract

N840

09SM0ZZ

Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent

Reposition Nasal Septum, Open Approach

J342

0FT44ZZ

Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular oedema

Resection of Gallbladder, Percutaneous Endoscopic Approach

K8010

J189

0UB98ZZ

Pneumonia, unspecified organism

Excision of Uterus, Via Natural or Artificial Opening Endoscopic

Code TotalDescription

Note: Top ICD-10-CM/PCS referring to clinical (medical and surgical) hospitalisation and outpatient surgery.


As a healthcare provider, José de Mello Saúde maintains its commitment to sustainable growth based on one of the organisation's strategic pillars: its unique clinical project. The main aim of this strategic position, which is common to all our hospital units, is to create value for patients. It is reflected in the uniqueness of our offer and the organisation of health care, its consistency in terms of different physicians, specialisms and hospitals and clinical excellence proven by the existence of quality management systems and benchmarking with other providers in Portugal and abroad.

Quality ManagementIn 2019, José de Mello Saúde committed itself to its continuous improvement cycle, continuing its Quality Management System’s models within the scope of its healthcare provision processes and quality and safety management methodologies. Subsequently, CUF hospitals and clinics successfully renewed ISO 9001:2015 certification of their quality management systems, thereby maintaining ongoing development of the José de Mello Saúde culture and practice of values. CENES maintained its ISO 13485 certification for maintenance of its medical device quality management system. The Adult Rectal Cancer Centre of Reference at the CUF Infante Santo Hospital and CUF Descobertas Hospital maintained its ACSA accreditation.

The Lisbon Breast Integrated Diagnosis and Treatment Unit, composed of its two centres at Hospital CUF Infante Santo and Hospital CUF Descobertas is certified by the EUSOMA clinical quality reference.

Hospital CUF Porto maintained its Joint Commission International (JCI) accreditation, continuing to have a strict audit process.

This is how it is continuing to step up its commitment as a healthcare provider of excellence.

In 2019, Braga Hospital maintained its ISO 14001:2015 Environmental Certification and OHSAS 18001:2007 Organisational Health and Safety Certification, both from

Société Générale de Surveillance SGS. It also kept its accreditation from the Casper Healthcare Knowledge System (CHKS).

After an annual reassessment, Hospital Vila Franca de Xira maintained its accreditation from the Joint Commission International (JCI). Its ISO 14001:2015 environmental certification was also confirmed. It migrated from OHSAS 18001:2007 certification of its occupational health and safety system to ISO 45001 and maintained ISO 9001:2015 certification of its quality management system in clinical and support services.

Patient SafetyPatient safety is a strategic priority for José de Mello Saúde and it consolidates its commitment to a unique clinical project that takes the form of clinical excellence of health care and a patient-oriented response.

The Safety and Clinical Risk Management Programme, which is common to all José de Mello Saúde units, is developed by multidisciplinary teams in articulation with the Medical and Nursing Boards. They establish common policies and courses of action to ensure compliance with the best recommended practices and implementation of a cycle of continuous improvement, thereby reinforcing the single operator model.

4. CLINICAL QUALITY AND SAFETY


The 2015-2020 National Patient Safety Plan set up by Ordinance 1400-A/2015 of 10 February 2015 covers the work done by José de Mello Saúde under the safety and clinical risk management programme in hospital units by the clinical risk management committees and the local coordination groups of the programme for prevention and resistance to antimicrobials. This plan has the following goals:

1. Increase the in-house safety culture;

2. Increase communication security;

3. Increase surgical safety;

4. Increase safety in the use of medication;

5. Ensure unequivocal identification of patients;

6. Prevent falls;

7. Prevent the occurrence of pressure ulcers;

8. Ensure systematic practice of incident notification, analysis and prevention;

9. Prevent and control infections and antimicrobial resistance.

Safety cultureOn the recommendation of the World Health Organisation and of the Council of the European Union, the healthcare professionals’ perception of the safety culture of the institution where they work is an essential condition for changing their behaviours. This will also be crucial to achieving better levels of safety and quality in the care provided to patients.

Safety in CommunicationRecognising that communication is an essential pillar of patient safety, particularly at the time of transfer of responsibility for healthcare delivery, José de Mello Saúde continued to step up the following measures in 2019:

• ISBAR Methodology (Identification; Current Situation; Background; Evaluation; Recommendations) for the transition of care

• Read-back on verbal statements

• Traceable communication of critical results

These measures are designed to ensure precise, timely communication of information between healthcare professionals. The goal is to avoid communication gaps that may lead to serious breaks in the continuity of care and adequate treatment, thereby allowing for incidents that negatively affect the patient.

Surgical Safety In 2019, José de Mello Saúde continued to perform a considerable number of surgeries. It maintained its focus on the safety of the surgical patient’s circuit, with the “Safe Surgery Saves Lives” project’s overarching monitoring.

The project encompasses the following dimensions:

• Pre-anaesthetic evaluation

• Anaesthetic consent

• Pre-surgical evaluation

• Surgical consent

• Surgical safety checklist

• Surgical Apgar Index

• Surgical follow-up

In line with the 2015-2020 National Action for Patient Safety, the aims of José de Mello Saúde’s Safe Surgery are:

1. Use the surgical safety checklist

2. Reduce the non-compliance rate in using the surgical safety checklist

3. Mitigate the risk of unacceptable surgical incidents

Medication-use safetyTop-alert or high-risk medications are those with a high risk of causing significant harm to the patient as a result of failures in their utilisation process. Though these errors are infrequent, their consequences tend to be more severe.

José de Mello Saúde complies with the 2015-2020 National Patient Safety Plan in the use of medication. Its units therefore develop, implement and monitor:

• Rules on safe medication practices;

• Compilation and circulation of maximum-alert medication lists;

• Definition and dissemination of medication lists of drugs with orthographic, phonetic or similar names;

• Special marks for medicines with a similar spelling, sound or appearance.

CUF PPP

97% 84%

98% 92%

98% 98%

2017 SSC rate1

2018 SCC rate1

2019 SSC rate1

1 Number of completed Surgical Safety Checklists / no. of surgeries in the central operating theatre

Surgical Safety Checklist (SSC) Usage Rate


FallsIn 2019, José de Mello Saúde maintained its focus on the prevention of falls in hospital. The risk of falls depends on various factors and can have a significant impact on patient mobility and quality of life. It can also increase the cost of health care. José de Mello Saúde monitors the patient falls indicator in order to remain fully abreast of the extent and characteristics of the problem. Our fall prevention strategy consists of:

• Using the Morse Fall Scale to assess the risk of falls in adult patients;

• Using the Humpty Dumpty Scale to assess the risk of falls in paediatric patients;

• Implementing preventive measures based on the risk of falling;

• Identifying patients with a high risk of falling;

• Involving the patient/carer in fall prevention;

• Reporting falls.

Notification system for adverse events Consolidation of the incident reporting, analysis and prevention system now represents a crucial, overarching tool in the development of a patient safety culture, thereby strengthening the purpose of the organisational learning and reinforcing a non-punitive culture.

With significant participation by employees at José de Mello Saúde’s units, it has made a notable contribution to collecting, aggregating and analysing clinical information, with a focus on causes, risks, hazards and vulnerability, plus full traceability of the effectiveness of improvement measures:

Infection controlInfection rates: General indicatorsIn 2019, José de Mello Saúde consolidated its active culture of preventing infection at its units, using epidemiological vigilance and establishing common policies and courses of action for controlling infection and antibiotic resistance throughout. This culture is based on a clinical coordination structure consisting of the executive sections of all the units’ local coordination groups.

In order to prevent, detect and control infections in the hospital environment, the culture of good practices in the main developed areas was reinforced across the units, such as epidemiological surveillance and infection control associated with health care, monitoring infection rates and resistance to antimicrobials, awareness campaigns, training actions for professionals and clients, as well as plans for internal audits of practices.

In compliance with the indicators set out in the public-private partnership hospital management contract, rates of surgical wound infections in procedures at different risk levels, urinary tract infections in catheterised patients, respiratory infections associated with mechanical ventilation and nosocomial bloodstream infections in patients after central venous catheter placement are also monitored.

HBCUF HVFX

-0.09 -

0.13- 0.04

1 Patient falls (%)

2 Indicator B17: “Hospitalisation falls” (%)

1 Number of patient falls reported for inpatients on the HER+ platform per 100 days of hospitalisation.2 Management Contract, B17 – Falls during hospitalisation indicator. [Number of patient falls

during hospitalisation, with discharge from hospital during the period under analysis / Total number of hospitalisation days generated by patients discharged from hospital during the period under analysis]. HB reference rate = 0.15% | HVFX reference rate = 0.11%

Patient falls during hospitalisation in 2018

1465

2018

1627

1246

1383

2017

856

2019

2252

Total Events Reported - Evolutionary Analysis

PPPCUF

Braga Hospital posts data up to August 31.


Reference value

Reference value

Accumulated 2019

Accumulated August 2019

1.74 ‰ 1.90 ‰

3.1 ‰

-

9.14%

0.16%

6.90%

0.40%

11.63%

4.75%

0.03%

10.34%

4.24%

-

5.73 ‰

2.62%

3.5 ‰

N/A

3.80%

1.40%

3.64%

0.52%

34.00%

2.49%

0.37%

10.00%

-

N/A

7.53 ‰

10.00%

B5 Rate of Nosocomial Bloodstream Infections in patients undergoing Central Venous Catheterisation (CVC)

B6 Urinary Infection Rate in Aligned Inpatients

B7d Surgical Wound Infection Rate in Scheduled Surgical Procedures in Risk Users 3

B7 a) Surgical wound infection rate in scheduled surgical procedures in Risk 0 users

B8 Rate of respiratory infection associated with mechanical ventilation in the ICU

B7b Surgical Wound Infection Rate in Scheduled Surgical Procedures in Risk Users 1

B6 Rate of urinary infection in hospitalised patients

B7 c) Surgical wound infection rate in scheduled surgical procedures in Risk 2 users

B7a Surgical Wound Infection Rate in Scheduled Surgical Procedures in Risk Users 0

B5 Nosocomial bloodstream infection rate in patients undergoing CVC

B7c Surgical Wound Infection Rate in Scheduled Surgical Procedures in Risk Users 2

B7 Global Surgical Wound Infection Rate in Scheduled Surgical Procedures

B7 d) Surgical wound infection rate in scheduled surgical procedures in Risk 3 users

B8 Respiratory Infection Rate Associated with Mechanical Ventilation at the ICU

B7 b) Surgical wound infection rate in scheduled surgical procedures in Risk 1 users

Infection Rates - General HVFX Indicators

Infection Rates - Braga Hospital General Indicators

Legionella: Prevention and ControlLegionella is a pathogenic group of Gram-negative bacteria that includes the Legionella pneumophila species, which causes a pneumonia called Legionnaires’ disease and, more rarely, a flu-like illness called Pontiac fever.

Legionella is able to survive for long periods of time in hostile environments, which is why it is easily spread. This spreads occurs via aerosol-producing sources, such as hot water from taps and showers.

The prevention and control of Legionella requires permanent maintenance of a specific chemical and thermal health barrier. A fragile health barrier, even if isolated and transient, depending on other factors, contributes to the creation of favourable conditions for an outbreak.

José de Mello Saúde maintained its water safety plan in all its units in 2019.

National Health Evaluation System (SINAS)In 2019, José de Mello Saúde’s participation in the National Healthcare Evaluation System (SINAS) for hospitals organised by the health regulator (ERS) was consolidated and the good results and ongoing improvement in the quality of care provided were clear. Our involvement in the SINAS means that patients have access to appropriate, understandable information, which results in better-informed decisions.

All the José de Mello Saúde units are assessed for quality at the first level of evaluation, with a maximum score and stars.

HDCHCISHCPHCCHCTVHCSHCVHVFX

UnitClinical

ExcellencePatientSafety

Facilities and Comfort

Focus on the Patient

PatientSatisfaction

Provider complies with all required quality parameters


In the 2nd level of evaluation, restricted to the dimension of Clinical Excellence, the Hospital de Braga and the Hospital Vila Franca de Xira stand out in more areas with a maximum level of clinical excellence (3+). Hospital de Vila Franca de Xira achieved the highest classification in six clinical areas (Outpatient Surgery, Intensive Care Unit, Neurology - Stroke, Obstetrics - Prenatal Births and Care, Acute Pain Assessment and Paediatrics - Neonatal Care). Braga Hospital achieved the highest classification in four clinical areas (Outpatient Surgery, Gynaecology - Hysterectomies, Obstetrics - Prenatal Care and Delivery and Orthopaedics - Total Hip and Knee Arthroplasties).

In 2019, the CUF units achieved top scores for clinical excellence in stand-out areas such as Intensive Care Units, Orthopaedics, Paediatrics - Neonatal Care, Gynaecology and Outpatient Surgery.

SINAS internal monitoring toolIn 2019, José de Mello Saúde continued to implement effective improvement measures based on on-time monitoring of compliance rates by detail indicator in each area of the clinical excellence category. Consolidation of this monitoring tool, which was developed in 2017, was a important step in the process in terms of information management and the focus of clinical teams.

Clinical Quality IndicatorsOn the basis of information management, as a form of monitoring and learning, José de Mello Saúde fully codes its activity (based on ICD-10-CM/PCS) and involves its units with hospitalisation and outpatient surgery in benchmarking models that make it possible to evaluate and compare their performances in variables such as clinical efficiency and quality.

This assessment of clinical quality is measured with the help of IAmetrics, which enables José de Mello Saúde units to achieve greater efficiency and quality in the provision of healthcare thanks to monitoring of their results via methods that adjust to case complexity, on the basis of benchmarking with equivalent hospitals in Portugal and Spain. The performance assessment system is based on a comparison with standard values (indexed to risk), in which a better performance will have scores between 0 and 1.

Clinical AreaProfit/loss Unit

Outpatient Surgery HCD/HCP/HCC/HCTV/HCIS/HCV

Orthopaedics

Gynaecology

HCD/HCIS/HCS

HCD

Paediatrics: Neonatal care HCP

3+

3+

3+

3+

CUF Units PPP Units

0.16

0.89

0.50

1.07

0.71

0.97

0.77 0.89

Efficiency indicators

AAPDI

RAMI

RARI

Quality indicators

RARI

Standard = 1.0 | Adjusted for the risk of the probability of the occurrence of a given event based on the patient's characteristics, the type of admission, the pathology and the Health Unit. Figures resulting from the average between units.AAPDI: Average pre-op delay rate. Adjusted (scheduled + urgent) | RAMI: Risk-adjusted mortality index | RACI: Risk Adjusted Compilations Index | RARI: Risk Adjusted Readmissions Index.


CUF Oncology The CUF Oncology combines all the necessary resources in the network - professionals, equipment and facilities - in a pathology-based care model. Currently, it has a national clinical department made up of four doctors and is organised by 13 Integrated Diagnostic and Treatment Units (UDTI) per pathology. It is up to the UDTI to define and implement the necessary resources, clinical pathways, protocols and indicators of operational performance and transversal clinical quality within the context of its pathology. The CUF Oncology maintains a strong commitment to collaboration with the Portuguese National Cancer Registry. It has been contributing to the epidemiological study of cancer in Portugal since 2005 and continuously evaluates and monitors survival results of patients treated fully within the CUF network.

Maintaining a clear commitment to the current needs of each person with cancer and the clinical requirements of addressing cancer, CUF Oncology has the following main goals:

• Ensure a quick and accurate diagnosis;

• Ensure the patient’s staging and multidisciplinary discussion;

• Ensure that each patient diagnosed and discussed within the CUF network has a personalised treatment plan that responds to his/her needs and the objectives of his/her clinical team;

• Ensure post-treatment follow-up with patients with a monitoring plan for preventing relapses and an incentive for adopting or maintaining a healthy lifestyle.

With regard to investment in recognition of clinical quality through certification programmes, the CUF Lisbon Breast Unit (with CUF Descobertas and Infante Santo hospitals) once again successfully passed the certification follow-up audit by the clinical quality benchmark EUSOMA - European Society of Breast Cancer Specialists. This certification confirms that the Lisbon CUF Oncology Breast Unit fully complies with strict guidelines for services provided to patients, overall organisation and the experience and structure of multidisciplinary teams, which are components that ensure clinical excellence and safety in patient treatment and diagnosis. After four years of consolidating clinical quality processes and indicators, the Breast Unit is preparing for the recertification audit in 2020.

5. GROUP-WIDE AREAS


Breast Diagnostic and Integrated Treatment UnitFounded 12 years ago, the Lisbon breast IDTU was the first private unit dedicated to breast cancer in Portugal and has already published data.

This IDTU has a multidisciplinary team dedicated to and specialising in the diagnosis and treatment of breast cancer, with vast experience in early detection and treatment of cancer in young women (<45 years of age). The healthcare professionals’ experience combined with cutting-edge technology makes it possible to provide a differential diagnosis of breast cancer in 48 hours and start the first treatment in less than three weeks.

Armed with all the necessary skills, the breast unit’s mission is:

• Providing excellent clinical care in diseases of the breast, particularly breast cancer and permanently ensuring a suitable, innovative offering, considering all the needs of patients and their care providers;

• Promoting health and preventing and combating breast cancer through awareness-raising and education on the adoption of healthy habits and early diagnosis;

• Cooperating in teaching and scientific research in the field of cancer. As a member of SOLTI, the Breast Unit works with NMS/CEDOC and FML/Instituto de Medicina Molecular (Institute of Molecular Medicine).

This unit is certified by the EUSOMA clinical quality standard, as it fully met its clinical quality targets in the last follow-up audit:

EvaluationTarget

80%

80%

80%

5%

90%

90%

90%

95%

91%

100%

7%

95%

96%

96%

Preoperative Diagnosis

Percentage of patients with a single breast surgery

Suitable hormone therapy

Cases referred for genetic counselling

Complete characterisation of predictive and prognosis factors

Discussion in a multidisciplinary meeting

Patients with breast preservation surgery receiving radiotherapy

Indicator


Value Based Healthcare Program As healthcare provider, José de Mello Saúde has consolidated its culture of quality by strengthening its clinical management model, which is based on patient-oriented services. The Value Based-Healthcare Program, supported by a Clinical Advisory Board that promotes the measurement of health value according to a transversal view, acts as a strategic and fundamental initiative for a Differentiating Clinical Project.

Implementation of each initiative for measuring outcomes is based on the methodology adopted by The International Consortium for Health Outcomes Measurement (ICHOM), and successful implementation depends on the clinical leads and their teams who operationalise the evaluation standards related to the patients’ quality of life and evolution over the course of treatment.

In 2019, José de Mello Saúde consolidated its clinical outcome measurement cycle and importance for the patient in terms of quality of life. Consequently, our strategy is to monitor compliance with processes and conduct a rigorous analysis of information collected. This enables us to adjust clinical practices with the clear objective of improving quality of service and the patient’s own experience. Following this line of action, in 2019,

José de Mello Saúde disseminated its value measurement processes in health in a vast number of pathologies and units:

In addition, we have also strengthened our external relationships and currently have ongoing strategic partnerships that are of interest to the organisation, academically and domestically in the area of value-based healthcare, such as:

• Health Cluster Portugal, with the Cataract Surgery Project

• NOVA Institute for Value Improvement in Health and Care - NOVA Health

• Value4Health Collaborative Laboratory (FCT - JMS / NOVA / Vodafone / Fraunhofer Consortium)

6. VALUE IN HEALTHCARE

10

+6,500

+12,000

28

11

Units

Patients

PROMs Collected

Teams

Pathologies(+3 to start)


Measurement of Clinical OutcomesIn 2019, José de Mello Saúde stepped up its strategy of measuring value in health by consolidating its methodologies for periodic monitoring and assessment of outcomes, thereby guaranteeing constant validation of information with working teams and their clinical leads for each pathology. The implementation of a management model that facilitates an analysis and discussion of the results on a semi-annual basis, thus ensuring a constant validation of the information that allows us to identify improvements and consequently to improve the practices with the objective of evidencing clinical excellence.

From a broader perspective, José de Mello Saúde had the opportunity to share all its experience in the implementation of health value measurement models by passing on its strategic vision of the organisation, according to the Value-based Healthcare Programme, concluding with the first outcomes for osteoarthritis of the knee.

The values represent the average of the scores with respect to all PROM’s collected at the corresponding time.

TIME2 years and 4 months

JAN17-APR19

SURGERIES

375PATIENTS

351

Clinical Forms Started

79%

Clinical Forms Completed

100%

PROMs Started

79%

PROMs COMPLETED

88%

25

0KOOS

BASE

48.350.8

48.4

31.3

39.3 40.0

1YR 2YR

50

50

75

100

Physical

1YRBASE

Mental

2YR

SF-12 - Average variation of scores

KOOS - Average range of scores

44.5 64.0 62.3


We also consolidated our methods and analysis of information for the other pathologies, in accordance with a six-monthly assessment model with discussion of outcomes by teams and clinical leads. The Peri-operative Medicine Project is a good, clear example of the systematisation of all the knowledge and experience that José de Mello Saúde has consolidated in the area of value measurement in health. The measurement of outcomes in a Perioperative Medicine perspective arises from a broader perspective than pathology and the need to monitor surgical patients who are at higher risk, with the aim of preoperative optimisation and strategies for early prevention, detection and treatment of complications.

Following the entry criteria or the monitoring of a population of greater risk and complexity, it was thus possible, in 2019, to consolidate a set of indicators that, duly analysed by clinical leaders, allowed us to make decisions at clinical level, by adjusting the patient process and circuit and for signalling the review of certain clinical processes that allowed an improvement in certain indicators, while also realising the potential associated with the collection of PROM's along the patient's pathway.

Given the clinical criteria of the eligible population, the interpretation of the results presented should have the appropriate framework for monitoring highly complex patients, compared to the standard patient.

Patient pathway and clinical monitoring

ProposalSurgical

Nursing Consultation

Anaesthesia Consultation

Patient fit for sur-gery?

Infirmary (PostOp) Hospital discharge Follow-up

Assessment of periodicity appropriate

to the pa-tient's risk

Surgery

Stabilisationof the patient

Yes

No

YEAR

2019

Monitored Episodes

334

0%

10%

0Moderate IntenseSlight

20%

30%

% P

atie

nts

eval

uate

d

Stage

50%

40%

Pain > 3 (rest) Pain > 5 (movement)

% Patients assessed with pain at the time

% of assessments of patients with pain greater than 3 by type of anaesthetic protocol

Follow-up: 24 hours

Follow-up: 30 days

Follow-up: 7 days

Follow-up: 6 months

Follow-up: 1 year

30%

48%

35%


Clinical assessments

Sem avaliação

5,7% 3,6%

90,7%

S

N

Intra-hospital Monitoring of Organ Complications

Internment Complications - Organs

Sem avaliação

5,7% 33,2%

61,1%

Com profilaxia

Sem profilaxia

Intra-hospital Monitoring of Post-operative Nausea and Vomiting

NVPO prophylaxis

Only 17 of the patients (5% of those evaluated) had PONV, with nausea and vomiting. Of the patients who had PONV, 11 did not undergo prophylaxis.

During hospitalisation, 3.6% of patients had organ complications, including gastrointestinal complications (ileus), neurological complications (delirium), acute kidney damage, neurological complications (delirium) and acute kidney injury.

During the follow-up period, 10 patients were hospitalised again (1 at 24h, 2 at 7 days, 4 at 30 days and 3 at 6 months). On the other hand, 17 patients required medical observation, 9 of which resulted in hospitalisation.

Hospitalisation Medical Observation

% Patients in need of hospitalisation or medical observation at the time

Follow-up:24 hours Follow-up:7 days Follow-up:30 days Follow-up:6 months Follow-up:1 year

0.4%0.8%

2.0%2.5%

0.0%

0.9%

2.1%

3.0%3.3%

0.0%


7. UNITS FACT SHEETCUF Infante Santo HospitalCUF Infante Santo Hospital opened in 1945. It was the founding facility of José de Mello Saúde, and was named CUF Hospital at the time. Currently, it presents itself as a reference unit at the national level in the provision of health care, with a vast and complete hospital offer. Given its complex hospital profile, it responds with remarkable clinical performance which is evident from the clinical quality and safety outcomes on which it is evaluated.

In 2019, it consolidated its investment in the creation of value by implementing two other pathologies in the scope of the Value-Based Healthcare programme, now measuring clinical outcomes for cataract disease, back pain, breast cancer and colon and rectal cancer.

The development of teaching and research activities is one of the best examples of the successful association between José de Mello Saúde and the Medical School at Universidade Nova de Lisboa.

Total replacements of the hip and knee: 3+ Outpatient surgery: 3+

Patient fall: most frequent type of incident.

141

18.2%

1.15

0.91

Beds (total)

Clinical Excellence

Type of incident (%):(Patient falls)

RAMI

Case mix

3+

Number of patient falls per 100 days of hospitalisation

3+

WHO/DGS rating: Satisfactory

3+

Completed surgical safety checklist rate

Starting evaluation

2nd level of evaluation

8

0.13%

0.79

63.4%

71

96.6%

0.54

1st level of evaluation

Indicator

Overall

Operating theatres

Patient Safety

Patient falls (%)

RACI

Focus on the User

Overall hand sanitising rate

Performance assessment methodology based on a comparison of performance with standard values, in which a better performance will score between 0 and 1.

Consulting rooms

Comfort of the Facility

Safe surgery (%)

RARI

User Satisfaction

National Healthcare Quality Assessment System (SINAS)

Patient Safety

Quality indicators

Complexity

Structure

CUF Infante Santo Hospital


CUF Descobertas HospitalOpened in 2001, CUF Descobertas Hospital is one of the most modern hospital units of the country, with a wide range of services, which include a top orthopaedic unit that hosts clinical specialists of international renown. This unit offers most medical and surgical specialities and its case mix includes such specialities as obstetrics, paediatrics and ophthalmology.

In 2019, it maintained excellent quality and clinical safety results, which are expressed by a number of evaluation indicators, such as a score of 3+ in clinical excellence in outpatient surgery, gynaecology - hysterectomy and orthopaedics (hip and knee replacement), in the SINAS evaluation. In 2019, it consolidated the measurement of clinical outcomes for cataracts, breast cancer, osteoarthritis of the knee and hip and back pain. It also set in motion processes for measurement of clinical outcomes in lung cancer.

Outpatient Surgery: 3+Hip and Knee Replacement: 3+

Hysterectomies: 3+

Medication/Intravenous fluids, most common type of incident.

171

25.1%

0.69

0.63

Beds (total)

Clinical Excellence

Type of incident (%):Medication / IV fluids

RAMI

Case mix

3+


3+


3+


Starting evaluation


12

0.06%

0.78

64.59%

118

99.4%

0.51


Indicator

Overall

Operating theatres

Patient Safety

Patient falls (%)

RACI

Focus on the User



Consulting rooms


Safe surgery (%)

RARI

User Satisfaction


Patient Safety

Quality indicators

Complexity

Structure

CUF Descobertas Hospital


CUF Porto HospitalCUF Porto Hospital opened in June 2010, marking an important milestone in private healthcare in the north of the country, providing a broad offer of medical and surgical specialities and permanent adult and paediatric care. This unit stands out for its performance in all areas of assessment of quality and patient safety, especially thanks to its 3+ rating in the area of outpatient surgery, paediatrics - neonatal care, in the clinical excellence category of the SINAS evaluation. In line with the Value-based Healthcare programme, it began defining processes for measuring clinical outcomes for lung cancer, cataracts and osteoarthritis of the knee. It also began gathering outcomes in cardiology at CUF Porto Instituto.

Organisational Management/Resources, Management of Patient Pathway; most common type of incident.

137

16.75%

0.81

0.72

Beds (total)

Clinical Excellence

Type of incident (%):(Organisational Management/Resources, Patient Pathway Management)

RAMI

Case mix

3+


3+


3+


Starting evaluation


11

0.09%

0.66

73%

76

97%

0.60


Indicator

Overall

Operating theatres

Patient Safety

Patient falls (%)

RACI

Focus on the User



Consulting rooms


Safe surgery (%)

RARI

User Satisfaction


Patient Safety

Quality indicators

Complexity

Structure

CUF Porto Hospital

Outpatient Surgery: 3+ Neonatal care: 3+


CUF Cascais HospitalCUF Cascais Hospital, running since 2008, offers inpatient care, a versatile intermediate care unit, permanent adult and paediatric care and a wide range of diagnostics solutions. It had positive results in the various areas of clinical quality and safety in 2019. Once again, it received a rating of 3+ in the area of outpatient surgery and orthopaedics (hip and knee replacement), in the clinical excellence category of the SINAS evaluation. The entire process for the measurement of clinical outcomes for cataract disease was consolidated in 2019.

Patient Pathway Management, most common type of incident.

31

26.46%

1.078

0.76

Beds (total)

Type of incident (%):(Patient Pathway Management)

RAMI

Case mix

3+

Outpatient Surgery: 3+


3+


3+


Starting evaluation


4

0.11%

1.03

73.7%

45

99.15%

0.388


Indicator

Overall

Operating theatres

Patient Safety

Clinical Excellence

Patient falls (%)

RACI

Focus on the User



Consulting rooms


Safe surgery (%)

RARI

User Satisfaction


Patient Safety

Quality indicators

Complexity

Structure

CUF Cascais Hospital


CUF Torres Vedras HospitalCUF Torres Vedras Hospital, which went into operation in 2008, provides inpatient care and permanent adult and paediatric care. It offers a wide range of specialties, the key ones being orthopaedics and general surgery. It has also shown good clinical performances in the areas of quality and patient safety. It received a rating of 3+ in the area of outpatient surgery in the clinical excellence category of the SINAS evaluation.

In line with the Value-based Healthcare Programme, it undertook a pilot project for measuring outcomes of chronic diabetes patients.


16

39.57%

0

0.76

Beds (total)


RAMI

Case mix

3+



3+


3+


Starting evaluation


3

0.05%

0.405

73.5%

28

99.91%

0.208


Indicator

Overall

Operating theatres

Patient Safety

Clinical Excellence

Patient falls (%)

RACI

Focus on the User



Consulting rooms


Safe surgery (%)

RARI

User Satisfaction


Patient Safety

Quality indicators

Complexity

Structure

CUF Torres Vedras Hospital


CUF Santarém HospitalCUF Santarém Hospital opened in 2015, as part of José de Mello Saúde’s strategy of growth and geographic expansion featuring a wide range of medical and surgical specialties. In 2019, it reinforced its culture of quality and patient safety via the external evaluation by the Portuguese Healthcare Regulation Authority (Entidade Reguladora da Saúde – ERS) in certain SINAS areas, and by participating in the IAmetrics clinical indicator benchmarking programme. This resulted in a comparative evaluation of its performances in the areas of clinical efficiency and quality, in which it obtained results with positive contributions that reflect its good performance.

As part of the Value-based Healthcare Programme, and extrapolating the ICHOM measurement guidelines, the hospital consolidated methodologies for assessing outcomes in peri-operative medicine. It also began measuring outcomes for osteoarthritis of the knee.


26

27.27%

0.556

0.85

Beds (total)


RAMI

Case mix

3+

Total replacements of the hip and knee: 3+


3+


3+


Starting evaluation


3

0.04%

0.901

72.6%

23

99.07%

0.224


Indicator

Overall

Operating theatres

Patient Safety

Clinical Excellence

Patient falls (%)

RACI

Focus on the User



Consulting rooms


Safe surgery (%)

RARI

User Satisfaction


Patient Safety

Quality indicators

Complexity

Structure

CUF Santarém Hospital


CUF Viseu HospitalCUF Viseu Hospital opened in 2016, and has a broad offering of medical and surgical specialties, diagnostic tests and speciality examinations. It is thereby helping to improve access to healthcare in the region. It immediately abided by the culture of quality and patient safety in the whole of José de Mello Saúde’s network of units.

In 2019, it continued to consolidate its culture of clinical quality and safety. It strengthened the monitoring and comparative evaluation processes for its clinical performance, in the IAmetricsclinical benchmarkingprogramme, involving a set of indicators in which it shows a solid, positive performance. It received a rating of 3+ in the area of outpatient surgery in the clinical excellence category of the SINAS evaluation.


35

41.63%

0.402

0.82

Beds (total)

Type of incident (%):(Medication / IV fluids)

RAMI

Case mix

3+



3+

WHO/DGS rating: Very satisfactory

3+


Starting evaluation


4

0.28%

0.799

77%

31

99.53%

0.404


Indicator

Overall

Operating theatres

Patient Safety

Clinical Excellence

Patient falls (%)

RACI

Focus on the User



Consulting rooms


Safe surgery (%)

RARI

User Satisfaction


Patient Safety

Quality indicators

Complexity

Structure

CUF Viseu Hospital


CUF Coimbra HospitalCUF Coimbra Hospital joined the CUF hospital network in 2018. Since then the hospital has reorganised the way it operates, incorporating methodologies and processes used in the other CUF network units. These included the introduction of a new version of its information system, alterations to infrastructures for better access and comfort for patients and an broadening of its offer.

CUF Coimbra Hospital currently offers a wide range of services. It includes outpatient and inpatient departments, four operating theatres, an imaging service and special gastroenterology exams with a team of excellent professionals.

CUF Coimbra Hospital has been strengthening the leading position of José de Mello Saúde in the Portuguese market. It forms part of its strategy of expansion in Portugal in an agenda of growth that generates value and follows the culture of quality and safety for patients embedded at all units in the José de Mello Saúde network.

Medication/Intravenous fluids; most common type of incident.

21

37.50%

0.85

Beds (total)

Type of incident (%):(Medication / IV fluids)

Case mix



4

0.10%

N/A

21

98.99%

Overall

Operating theatres

Patient falls (%)


Case mix for the last quarter of 2018, which was why the unit began coding medical and surgical inpatient and outpatient surgery incidents.

Consulting rooms

Safe surgery (%)

Patient Safety

Complexity

Structure

CUF Coimbra Hospital


Braga HospitalBraga Hospital is a National Health Service facility that has been managed by José de Mello Saúde since 2009 under a public-private partnership agreement. The agreement ended on 31 August 2019. This is a teaching hospital with considerable undergraduate medical training activity, highly influenced by its partnership with the School of Health Sciences at University of Minho, which is also dedicated to teaching and clinical research. It offers most medical and surgical specialties and has achieved good performance results in the different areas of clinical quality, in accordance with the targets and goals set. Braga Hospital received the highest clinical excellence (3+) rating in four specialities: Outpatient surgery, gynaecology: Hysterectomies; Obstetrics: Births and prenatal care and orthopaedics: Total replacements of the hip and knee.

Patient falls, most common type of incident.

658

38.13%

0.61

0.61

Beds (total)

Type of incident (%): (Patient's fall)

RAMI

Case mix

3+

4 specialties with ratings: 3+

B17 management contract indicator: falls during hospitalisation per 100 days

3+


3+


Starting evaluation


25

0.13%

0.95

86.3%

132

96.06%

0.95


Indicator

Overall

Operating theatres

Patient Safety

Clinical Excellence

Patient falls (%)

RACI

Focus on the User



* Data until August 26

Consulting rooms


Safe surgery (%)

RARI

User Satisfaction


Patient Safety

Quality indicators

Complexity

Structure

Braga Hospital


Vila Franca de Xira HospitalVila Franca de Xira Hospital also belongs to the Portuguese National Health Service and has been operated under a public-private partnership by José de Mello Saúde since June 2011. It resumed its operations in new facilities in 2014 so that it could provide healthcare services under excellent conditions. Similarly, the unit is committed to a culture of quality and safety for patients and it periodically and systematically tracks evaluation indicators for the different areas, in which it showed good performances. In 2019, Vila Franca de Xira Hospital achieved the highest level of clinical excellence (3+) in six specialities: Outpatient surgery, intensive care: ICU, comprehensive care: Acute pain assessment, paediatrics: Neonatal care, neurology: Strokes and obstetrics: Births and prenatal care.

In 2019, it consolidated its processes for measuring clinical outcomes for cataracts, in line with the Value-based Healthcare Programme.

313Beds (total)

16

33

Operating theatres

Consulting rooms

Structure

Vila Franca de Xira Hospital

Patient falls, most common type of incident. 24.03%

0.83

0.77

Type of incident (%):(Patient falls)

RAMI

Case mix

3+

6 specialties with ratings: 3+

B17 management contract indicator: falls during hospitalisation per 100 days

3+


3+


Starting evaluation

Grouping reference: AP21


0.044%

0.82

79.04%

100%

0.98


Indicator

Overall

Patient Safety

Clinical Excellence

Patient falls (%)

RACI

Focus on the User




Safe surgery (%)

RARI

User Satisfaction


Patient Safety

Quality indicators

Complexity


CLINICAL CODING (DRG)Healthcare provision at all José de Mello Saúde facilities is classified and grouped into diagnosis-related groups (DRGs), a classification system used for inpatients in acute hospitals that groups patients into clinically coherent and similar groups from the point of view of consumption of resources.

The major diagnostic categories (MDCs) correspond to an organic system or aetiology, usually associated with a particular medical specialty, and constitute the first step in grouping episodes of diagnosis-related groups (DRGs) and are carried out according to the main diagnosis.

DRGs are grouped on the basis of coding of diagnoses, co-morbidities and procedures identified during treatment. Other factors that may influence DRGs are, for example, the patient's age or, in the case of new-born infants, their weight at birth.

At the facilities operating in public-private partnership (PPPs) - Braga Hospital and Vila Franca de Xira Hospital - DRGs serve as the basis of the contractual relationship. In private healthcare facilities, DRGs serve as the basis for the clinical management system, ensuring effective management and monitoring of quality indicators. At these facilities, clinical coding is carried out by a team of 18 coding doctors and three auditors.

Case mixAn overall production weighting coefficient which reflects the relativity of any given hospital against others in terms of their greater or lesser proportion of patients with complex pathologies and, consequently, higher consumption of resources.

The rate is determined by calculating the ratio between the number of equivalent patients weighted by the relative weights of their DRGs and the total number of equivalent patients.

IAmetricsRisk-adjusted mortality, complications and readmissions rate, i.e. the actual recorded rate weighted by the individual probability of each episode occurring, taking account of a number of pre-established indicators.

8. GLOSSARY


Board of Directors

Salvador Maria Guimarães José de Mello

_________________________________________________

Pedro Maria Guimarães José de Mello

_________________________________________________

João Gonçalves da Silveira

_________________________________________________

Rui Alexandre Pires Diniz

_________________________________________________

Rui Manuel Assoreira Raposo

_________________________________________________

Vasco Luís José de Mello

_________________________________________________

Inácio António da Ponte Metello de Almeida e Brito

_________________________________________________

Guilherme Barata Pereira Dias de Magalhães

_________________________________________________

Paulo Jorge Cleto Duarte

_________________________________________________

Catarina Marques Rocha Gouveia

_________________________________________________

Luis Eduardo Brito Freixial de Goes

_________________________________________________

Vera Margarida Alves Pires Coelho

_________________________________________________

Celine Dora Judith Abecassis-Moedas

_________________________________________________

Raúl Catarino Galamba de Oliveira

CLINICAL QUALITY AND SAFETYREPORT

clinical quality and safety report

Documents