effectiveness of key indicators as instrument in detecting risks in healthcare ine borghans
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Effectiveness of key indicators as instrument in detecting risks in healthcare Ine Borghans. Methods of Supervision. Risk Indicators. Thematic. Quality system. Suspicions criminal offenses. Incidences. Methods of Supervision. Risk Indicators. Thematic. Quality system. - PowerPoint PPT PresentationTRANSCRIPT
Effectiveness of key indicatorsas instrument in detecting risks in healthcare
Ine Borghans
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Methods of Supervision
Thematic
Incidences
Quality syste
m
Risk Indicators
Suspicions criminal offenses
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Methods of Supervision
Thematic
Incidences
Quality syste
m
Risk Indicators
Suspicions criminal offenses
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Risk indicators
Used in ‘Risk-based' supervision
To render the risk of healthcare services measurable and transparent.
Developed in cooperation with the health care providers.
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Canary indicator of the coal mine
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Hospital adverse events often result in a longer length of stay (see references on next slide)
We developed a new indicator that uses the unexpectedly long length of stay (UL-LOS) as a potential risk factor for unsafe care.
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References1. Hoonhout LH, de Bruijne MC, Wagner C, Asscheman H, van der Wal G, van Tulder MW. Nature, occurrence and consequences
of medication-related adverse events during hospitalization: a retrospective chart review in the Netherlands. Drug Saf. 2010 10/01;33(10):853-64.
2. Hoonhout LH, de Bruijne MC, Wagner C, Zegers M, Waaijman R, Spreeuwenberg P, et al. Direct medical costs of adverse events in Dutch hospitals. BMC Health Serv.Res. 2009;9:27.
3. Sari AB, Sheldon TA, Cracknell A, Turnbull A, Dobson Y, Grant C, et al. Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large NHS hospital. Qual.Saf Health Care 2007 12;16(6):434-9.
4. Ehsani JP, Jackson T, Duckett SJ. The incidence and cost of adverse events in Victorian hospitals 2003-04. Med.J.Aust. 2006 06/05;184(11):551-5.
5. Cho SH, Ketefian S, Barkauskas VH, Smith DG. The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nurs.Res. 2003 03;52(2):71-9.
6. Camp M, Chang DC, Zhang Y, Chrouser K, Colombani PM, Abdullah F. Risk factors and outcomes for foreign body left during a procedure: analysis of 413 incidents after 1 946 831 operations in children. Arch.Surg. 2010 11;145(11):1085-90.
7. Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS, et al. Factors associated with complications in older adults with isolated blunt chest trauma. West J.Emerg.Med. 2009 05;10(2):79-84.
8. Williams DJ, Olsen S, Crichton W, Witte K, Flin R, Ingram J, et al. Detection of adverse events in a Scottish hospital using a consensus-based methodology. Scott.Med.J. 2008 11;53(4):26-30.
9. Kaushal R, Bates DW, Franz C, Soukup JR, Rothschild JM. Costs of adverse events in intensive care units. Crit.Care Med. 2007 11;35(11):2479-83.
10. Rice-Townsend S, Hall M, Jenkins KJ, Roberson DW, Rangel SJ. Analysis of adverse events in pediatric surgery using criteria validated from the adult population: justifying the need for pediatric-focused outcome measures. J.Pediatr.Surg. 2010 06;45(6):1126-36.
11. Schioler T, Lipczak H, Pedersen BL, Mogensen TS, Bech KB, Stockmarr A, et al. Incidence of adverse events in hospitals. A retrospective study of medical records. Ugeskr.Laeger 2001 Sep 24;163(39):5370-8.
12. Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004 May 25;170(11):1678-86.
13. Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S. Adverse events in New Zealand public hospitals I: occurrence and impact. N.Z.Med.J. 2002 Dec 13;115(1167):U271.
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Indicator: Percentage of patients with an unexpectedly long length of stay (UL-LOS)
Methods:• Based on a prolonged length of stay of more than 50%• Standardisation for patients’ age, primary diagnosis and main
procedure• Three strata of hospitals:
31 general hospitals24 tertiary teaching hospitals8 university medical centres
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Why based on a prolonged length of stayof more than 50%?
• to include patients that stayed longer because of complications and adverse events
• and not patients that just stayed a little bit longer because of variations in the treatment, such as in logistics
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Example
- patient of 18 years old- appendicitis - appendectomy
Expected LOS 3,4 dagen3,4 + 1,7 = 5,1 days
Actual LOS 6 days or more: UL-LOS
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Results
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How does the Inspectorate use this indicator?
Most important problem: hospitals without UL-LOS percentage
Other hospitals: High percentage is an important signal
Inspectors ask to inspect detailed information per specialism
Patients with UL-LOS: record reviewing to learn what went wrong
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PRO’s and CON’s of working with one key indicatorPro:• Les administrative burden for caregivers• Much easier for the inspector
Contra:High demands regarding to this specific indicator:• validity• reliability• comparability
Outcomes are not compensated by other indicators!
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Canary indicator of the coal mine
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Aviation: dashboard with some key indicators
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3 Indicators which may reveal risk of unsafe care
Sub-optimal quality of care
Unexpectedly long LOS*
Unplanned readmissions**
Higher than expected mortality***UN
DE
SIR
ABLE
OUT
COMES
* Indicator described in this thesis**Indicator yet to be developed*** Indicator already available (HSMR)
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Thanks for your attention!