1. Leifur Bardarson MD Landspitali - University Hospital ICELAND 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 Leifur Bardarson MD, Chief Medical Doctor Department of Quality Assurance Landspitali – University Hospital Reykjavik ICELAND

2. Nordic Council of Ministers 2000 – 2003 W ORKING G ROUP ON Q UALITY M EASUREMENTS IN H EALTH C ARE Q UALITY D ECLARATION Q UALITY I NDICATORS

3. Nordic Council of Ministers 2004 – 2006 WORKING GROUP ON QUALITY INDICATORS IN HEALTH CARE Charman: Jens Gøttrik, Chief Medical Officer, Danmark 2004 – 2006 WORKING GROUP ON QUALITY INDICATORS IN HEALTH CARE Charman: Jens Gøttrik, Chief Medical Officer, Danmark G ENERIC AND S PECIFIC I NDICATORS P REVENTIVE M EASURES M ENTAL H EALTH P RIMARY C ARE P ATIENT P ERSPECTIVE P ATIENT S AFETY

4. Leifur Bardarson MD Landspitali - University Hospital ICELAND THE INDICATOR JOURNEY OF THE GROUP THERE ARE HUNDREDS OF WELL DEFINED INDICATORS THE INDICATOR BUFFET

5. Leifur Bardarson MD Landspitali - University Hospital ICELAND THE INDICATOR JOURNEY OF THE GROUP THE INDICATOR BUFFET OECDAHRQ WHO Denmark Sweden Norway

6. Leifur Bardarson MD Landspitali - University Hospital ICELAND THE INDICATOR JOURNEY OF THE GROUP DID THEY TASTE GOOD ?

7. Leifur Bardarson MD Landspitali - University Hospital ICELAND 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 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

8. Leifur Bardarson MD Landspitali - University Hospital ICELAND Jes Søgaard 1982

9. Leifur Bardarson MD Landspitali - University Hospital ICELAND THE GROUPS PRESENT MENU OECD INDICATORS STANDARDISED IN-HOSPITAL MORTALITY IHI´s TRIGGER TOOLS SAFETY CULTURE (AHRQ) OECD INDICATORS STANDARDISED IN-HOSPITAL MORTALITY IHI´s TRIGGER TOOLS SAFETY CULTURE (AHRQ)

10. Leifur Bardarson MD Landspitali - University Hospital ICELAND SAFETY CULTURE UNSPOKEN NORMS 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) (James Reason 2006)

11. Leifur Bardarson MD Landspitali - University Hospital ICELAND S AFETY C ULTURE Western airlineAirline from former eastern Europe Probability of fatal outcome 1/11.000.0001/250.000 DIFFERENCE = CULTURE Health Care 1/1.000

12. Leifur Bardarson MD Landspitali - University Hospital ICELAND AHRQ HSPSC Hospital Survey on Patient Safety Culture P ATIENT S AFETY C ULTURE Is there a program for evaluation of safety culture ? YesNoNotes National level Regional level Institutional level Indicator ?: Evaluation of patient safety culture

13. Leifur Bardarson MD Landspitali - University Hospital ICELAND Postoperative pulmonary embolism or deep vein thrombosis OECD INDICATOR PS 07 - AHRQ PSI 12 Indicator All surgical procedures318137 Definition: Cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) per 100.000 population

14. Leifur Bardarson MD Landspitali - University Hospital ICELAND “NEW” INDICATOR PS 07,1 Postoperative pulmonary embolism or deep vein thrombosis after knee or hip replacement Indicator Knee or hip replacements20420818%*) 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.

15. Leifur Bardarson MD Landspitali - University Hospital ICELAND Post op sepsis OECD INDICATOR PS 08 - AHRQ PSI 12 Definition: Cases of sepsis per 100.000 population with an operating room procedures IndicatorS All surgical procedures231662

16. Leifur Bardarson MD Landspitali - University Hospital ICELAND “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 Indicator Knee or hip replacements290181691%*) *) Nasser S. The incidence of sepsis after total hip replacemant arthroplasty. Seminars in Arthroplasrty 1994; 5:153-159.

17. Leifur Bardarson MD Landspitali - University Hospital ICELAND “NEW” INDICATOR PS 08,2 Post op sepsis after Bowel surgery Definition: Cases of sepsis per 100.000 population with an operating room procedures Indicator Bowel surgery892830

18. Leifur Bardarson MD Landspitali - University Hospital ICELAND OECD INDICATOR PS 17 Obstetric trauma vaginal Definition:Percentage (%) of vaginal lacerations (3rd or 4th degree lacerations) of vaginal deliveries Data collected (working data) Denmark2,56 % Finland0,11% Greenland1,64 % Iceland5,3 % Norway3,5 % Sweden4 %

19. Leifur Bardarson MD Landspitali - University Hospital ICELAND OECD INDICATOR PS 17 Obstetric trauma vaginal How to present this data to users Likelihood of that you will not experience vaginal trauma during vaginal delivery is: Denmark97,44 % Finland99,89% Greenland98,36% Iceland94,70 % Norway96,5 % Sweden96 %

20. Leifur Bardarson MD Landspitali - University Hospital ICELAND Foreign body left during procedure COUNTRY Reported incident: Yes / No Denmark Yes No Finland Yes No Iceland Yes No Norway Yes No Sweden Yes No

21. Leifur Bardarson MD Landspitali - University Hospital ICELAND S UMMARY 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 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

22. Leifur Bardarson MD Landspitali - University Hospital ICELAND SAFETY CAN BE LOOKED AT FROM MANY DIFFERENT ASPECTS