Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Il Miglioramento della Qualità
e della Sicurezza
Ferrara, 6
thMay 2008
Reli Mechtler Head of
Department for Health System Research National Center for Performance Measurement
University of Linz www.ipg.uni-linz.ac.at
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Topics
Dimensions of Quality and the role of Safety
- the role of indicators in the various
dimensions
Assessment-Systems and the importance of
clinical indicators
Quality implies Safety
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Dimensions of Quality
Q - Culture
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Patient Safety
Performance
Improvement
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
The role of indicators in the various
dimensions
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Accountability
Measurement – Assessment Systems
(external/internal: Certification, Accreditation, Excellence Model;
internal: QIP)
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Patient Safety
Safe clinical practice
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Q-Dimension: Accountability
internal External + internal external Trans-parency Internal self assessment identification of crucial areas => improvement Information internal/external interventions(state of art) for planning; technical safety Role/ Purpose Health providers, Management Board of facilities Decision makers, Health providers, Patients Government, Decision markers Target Group Clinical Outcome-Indicators (adverse events, complications, morbidity0)patient safety indicators
Clinical process-Indicators
(Diagnose-, procedure related; patient level)
Structure-Indicators
(Ressources, No and type of procedures, etc.) technical standards (Risk
Management)
Type of Q-Indicators
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Certification Accreditation„Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
2a.15b WI - for hip arthoplasty patients w ith NNIS-Risk Index 1 Annual rates 2002 - 2006 0 0,5 1 1,5 2 2,5 3 3,5
Ind. 2a.15b AU n=14 Ind. 2a.15b EU n=110 Ind. 2a.15b pw n=200 Ind. 2a.15b AU n=14 2,56 3,22 2,45 2,41 1,7 Ind. 2a.15b EU n=110 2,25 3,32 2,19 1,46 1,09 Ind. 2a.15b pw n=200 1,2 1,69 1,42 0,9 0,77
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
The role of indicators in the various
dimensions
-
Accountability
Measurement – Assessment Systems
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Patient Safety
Safe clinical practice
a) measures, covering clinical practice
(MEDSAFE)
b) clinical process indicators
c) clinical outcome indicators
(e.g. QIP)
d) criteria (checklists)
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Q-Dimension: Patient Safety – role of indicators
to avoid errors
support safe practice
Check list (criteria for
op-procedures)reporting systems
Error Management
(Clinical risk
management)
internal self assessment; finding areas of risk, avoid serious harm, analysis; improve patient safety measures covermedication practice: Ordering, dispensing, dose, administration
MEDSAFE
Internal self assessment identification of crucial areas => improve patient safety/CQI Clinical Outcome Indicators(Infections, periop. Mortality, unplanned return OP/ICU, etc.)
QIP
Role/Purpose
Type of
Q-Indicators/Measures
Examples
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Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Assessment-Systems and the importance of
clinical indicators
„Links“ between assessment-programs,
strategic tools, patient safety and
clinical indicators
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Indicators covering various dimensions
yes Checklist planned, reporting system QIP-Indicators CQI QIP-Indicators one of the very
few hospitals which strive for accreditation: Evidenz for clinical outcome measurement Hospital C no QIP-Indicators MEDSAFE Program + Indicators QIP-Indicators Hospital B yes Checklist (op-procedures) QIP-Indicators MEDSAFE Program + Indicators QIP-Indicators BSC: to measure strategic goals – outcome indicators are needed Hospital A Coord. by Q-Board Error management/ Clinical risk management Patient Safety Internal self Assessment Clinical outcome Assessment systems/ Strategic tools Participation in QIP Accountability
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Indi-cators strat. goals Mission Indi-cators strat. goals Performance Indi-cators strat. goals Ressources Indi-cators strat. goals Staff Patient Customer
Organisation
Balanced Scorecard
QIP
„Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Surgical Units:
2a + 2b; 5;
Obstetrics:
4 + 6
ICUs:
1a + 1b; 9
BSC
BSC
Hospital A:
QIP-Indicators
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Hospital C:
Use following indicators to fulfill all accreditation
criteria
(clinical outcome measurement):
1a. Device associated Infections in Intensive Care Unit
1b. Device Use in Intensive Care Units
2a. Surgical Site Infections
2b. Antibiotic Prophylaxis for Surgical Procedures
3. Inpatient Mortality
4. Neonatal Mortality
5. Perioperative Mortality
6. Management of Labor
10. Unscheduled Returns to the Operating Room
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Used MEDSAFE Measures
(Self reporting)
Medication Administration Devices Malfunctioned When Being Serviced
4.11b
Medication Administration Devices Malfunctioned during Medication Administration
4.11a
Medication Administration Devices Malfunctioned 4.11
Complications at Injection Site Following Injection 4.8
Medications Ordered for Patient with a Dokumented Allergy to those Medications
1.10
Incomplete Orders that Required Call Back to Physicians 1.7
Measure Name
Measure
Number
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
Examples of improvement strategies implemented:
Medication
(on admission)
will be checked by pharmacists to
guarantee a complete medication in regard to the changes
between the prescribed medication by th GP to the
hospital list
Strategies in regard to drug labeling, packaging and
nomenclature
Guidelines
(interdisciplinary)
for medication management.
(drugs will be dispensed only by defined staff, directly out
of the package and after the check of the order).
The participation in MEDSAFE leads also to long term
improvement strategies like the implementation of a
computerized central ordering and dispensing system
Institute for Health System Research – University of Linz „Indicatori per migliorare la Qualità e la Sicurezza in Sanità“ Ferrara, May 2008
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Q u a l i t y C u l t u r e
Performance
Improvement
Safe
Safe
Safe
Safe Clinical
Clinical
Clinical
Clinical Practice
Practice
Practice
Practice
Patient Safety
e x te rn a l: s tr u c tu re -p ro c e s s re la te d in te rn a l: o u tc o m e re la te d C Q IQuality implies Safety
incr ease SAFE TY increas e SA FE TY improves SAFETY
