Presentation title

Data for Patient Safety Canadian Association of Paediatric Health Centres Conference

Camille Poulin PT, B.Sc.P.T., CPHIMS-CA, PMPOctober 24 and 25, 2016Halifax, NS, Canada

CGI Group Inc. CONFIDENTIAL

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TopicsImproving patient safety - methods and mechanisms Trigger toolsPatient safety indicators, reporting, and actionable insightsThe data behind patient safetyProblemOpportunityExample use case and demoNew use cases? Whats coming next?

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3Methods and Mechanisms Care is providedAs planned? How do you know?Detection & Reporting

Voluntary Reporting

Chart Audit Interviews Surveys

Patient or Family Report

Trigger Tools - Global

Trigger Tools - Interventionist

Indicators and Reporting

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Trigger tools

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Trigger Tool for Measuring Adverse Drug EventsIHI Skilled Nursing Facility Trigger Tool for Measuring Adverse EventsTrigger Tool for Measuring Adverse Drug Events in a Mental Health SettingSurgical Trigger Tool for Measuring Peri-operative Adverse EventsIntensive Care Unit Adverse Event Trigger ToolPediatric Trigger Toolkit: Measuring Adverse Drug Events in the Childrens HospitalPerinatal Trigger ToolTrigger Tool for Measuring Adverse Events in the Neonatal Intensive Care UnitOutpatient Adverse Event Trigger Tool

CMS Adverse Drug Event Trigger Tool4

Review of the evidence key points for trigger toolsSampling strategy generalizable across an organizationGuided decision making encourages consistencyPragmatic approach to record reviewCan focus on high risk areas Standardized methodologyRate of harm amenable to organizational monitoring

In general, there is widespread support for use of trigger tools

includes structured and unstructured data

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Results: using trigger tools 6Canadian Paediatric Adverse Events StudyUsed the CAPHC Paediatric Trigger Tool - rate, type, severity, and preventability Compare adverse event epidemiology - academic paediatric centres and community hospitals9.2% of children hospitalized in Canada experience adverse eventsAcademic paediatric centres: more surgical AEsCommunity hospitals: more AEs related to clinical management

Attention to surgical safety is the single most effective strategy for improving overall safety for paediatric care in Canada

Part of the patient safety answerPlanDoActStudy

Research

Detect

Report

Train& Learn

ImproveProcess

Align Culture

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Filling the trigger tool gaps8

Current methodological or resource constraints in using data for patient safety benefit whats missing and how can technology help?8

Coded data and indicators Coded/structured data in trigger toolsICD-11Clustering, diagnostic timing indicatorsAHRQ patient safety indicatorsHospital harm CIHI and CPSIHospital acquired conditions9

Trigger definitions relying on value ranges for specific physiological parameters, drug dosages, test results

Hospital Harm ProjectTogether, CIHI and the Canadian Patient Safety Institute (CPSI) are using administrative data to address gaps in patient safety measurement and information. There are 3 planned outputs from this project:A new facility-level measure: Hospital HarmMeasures the rate of acute care hospitalizations with at least 1 occurrence of unintended harm that could have been potentially prevented by implementing known evidence-informed practicesDesigned to help organizations identify patient safety improvement priorities and track progress over time

Patient Safety Indicators Overview - AHRQThe Patient Safety Indicators (PSIs) are a set of indicators providing information on potential in hospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.The PSIs can be used to help hospitals identify potential adverse events that might need further study; provide the opportunity to assess the incidence of adverse events and in hospital complications using administrative data found in the typical discharge record; include indicators for complications occurring in hospital that may represent patient safety events; and, indicators also have area level analogs designed to detect patient safety events on a regional level.

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The data reality 10

SOASH

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Alternate data reality11

The data opportunity12COLLECTClinical AdministrativeFOCUSDETECTPotential adverse eventsOther deviations from expected care trajectoriesMeaningful and Relevant Data PointsUnstructuredCoded

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The ecosystem are we ready?DataCulturePublic needs and perceptions

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https://www.england.nhs.uk/ourwork/tsd/care-data/

https://www.nih.gov/news-events/news-releases/survey-shows-broad-support-national-precision-medicine-study

.NHS England has taken the decision to close the care.data programme.https://www.england.nhs.uk/ourwork/tsd/care-data/

http://www.zdnet.com/article/brandis-to-criminalise-re-identifying-anonymous-data-under-privacy-act/

What the future holds for predictive and prescriptive adverse events detectionBe cautious but do somethingKeep in mind eSafetyAustralia: create a new criminal offence of re-identifying de-identified government data

Other things we can do for patient safety keep in mind market and economic conditions like the 80s and 90s saw reduce reuse recycle, we need to leverage, leach, and leap13

Use case: automated detection of triggers

Patient admittedDiagnosisTreatmentplanProcedures & InterventionsPatientdischargedData captured regarding care provided

342516

Review & Classify

AE awareness and preventionAdverse event detection

Automated identification of IHI triggers14

We have structured our work around the IHIs Global Trigger Tool; however, we are willing to explore how the underlying rigor and methods may be further expanded and researched. 14

Trigger tool automation demonstration 15

Trigger tool automation demonstration 16

Creating solutions17

OCRECM

P____________________________

NLP, Analytics

Leverage, leach, and leapfrog17

Expanding the use case: real time detection of triggers

Patient admittedDiagnosisTreatmentplanProcedures & InterventionsPatientdischargedData captured regarding care provided

342516

Review & Classify

AE awareness and preventionAdverse event detection

Automated identification of IHI triggers18Adverse event preventionD1D2D3

We have structured our work around the IHIs Global Trigger Tool; however, we are willing to explore how the underlying rigor and methods may be further expanded and researched. 18

Contact InformationCamille Poulin PT, B.Sc.P.T., CPHIMS-CA, PMPDirector, Consulting

camille.poulin@cgi.com 780-409-5522

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ReferencesAnne G Matlow, Catherine M G Cronin, Virginia Flintoft, Cheri Nijssen-Jordan, Mark Fleming, Barbara Brady-Fryer, Mary-Ann Hiltz, Elaine Orrbine, G Ross Baker. Description of the development and validation of the Canadian Paediatric Trigger Tool, BMJ Qual Saf 2011;20:416e423. doi:10.1136/bmjqs.2010.041152 Canadian Patient Safety Institute, Canadian Paediatric Adverse Events Study, 2013Health Quality & Safety Commission. 2016. The global trigger tool: A review of the evidence (2016 edition). Wellington: Health Quality & Safety Commission. Persephone Doupi, Karolina Peltomaa, Mika Kaartinen, Juha hman. IHI Global Trigger Tool and patient safety monitoring in Finnish hospitals - Current experiences and future trends. 2013.Schildmeijer K, Nilsson L, Perk J, et al. Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members. BMJ Open 2013;3:e003131. doi:10.1136/bmjopen-2013-003131Griffin FA, Resar RK. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition). IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2009. (Available on www.IHI.org)Department of Health and Human Services, Centers for Medicare & Medicaid Services: Adverse Drug Event Trigger Tool https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/Adverse-Drug-Event-Trigger-Tool.pdf Agency for Healthcare Research and Quality Patient Safety Indicators http://www.qualityindicators.ahrq.gov/modules/psi_overview.aspx Ghali et al ICD-11 for quality and safety: overview of the who quality and safety topic advisory group. International Journal for Quality in Health Care 2013; Volume 25, Number 6: pp. 621625 10.1093/intqhc/mzt074.Danielle A. Southern, Marc Hall, Deborah E. White, Patrick S. Roman, Vuaya Sundararajan, Saskia E. Droesler, Harold Pincus, William A. Ghali, Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data. International Journal for Quality in Health Care, 2015, 17. doi: 10.1093/intqhc/mzv096Southern DA, Pincus HA, Romano PS, Burnand B, Harrison J, Forster AJ, Moskal L, Quan H, Droesler SE, Sundararajan V, Colin C, Gurevich Y, Brien SE, Kostanjsek N, stn B, Ghali WA; World Health Organization ICD-11 Revision Topic Advisory Group on Quality & Safety; World Health Organization ICD-11 Revision Topic Advisory Group on Quality & Safety. Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11).Int J Qual Health Care. 2016 Feb;28(1):136-42. doi: 10.1093/intqhc/mzv099. Epub 2015 Dec 10.Canadian Institute for Health Information and Canadian Patient Safety Institute, Hospital Harm Project, https://www.cihi.ca/en/health-system-performance/quality-of-care-and-outcomes/patient-safety/key-projects-on-patient-safety http://www.patientsafetyinstitute.ca/en/toolsResources/Hospital-Harm-Measure/pages/default.aspx 20

Supplemental

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NLP

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National Coordination Council for Medication Error Reporting and Prevention Index for Categorizing Medication Errors