Patient Safety Monitoring in Acute Care in a Decentralized National Health Care System: Conceptual Framework and Initial Set of Actionable Indicators.

OBJECTIVES: Monitoring patient safety is critical for continuous quality improvement in acute care. We carried out a national project to identify a conceptual framework with core indicators that could be uniformly applied in the decentralized health system of Italy. METHODS: We used key international references to identify a framework with a core list of indicators and data sources for calculation in 4 hospitals in the Lombardy region. Two different data processing methods were applied: (a) centralized analysis of national databases and (b) decentralized data extraction and calculation using different hospital data available in Lombardy. RESULTS: Agreement was reached on a conceptual framework for patient safety monitoring in acute care, including structures, processes, and outcomes as vertical dimensions and health care needs as horizontal axes. We were able to compute 15 of 32 indicators through the application of a range of methods. The calculation of indicators using national databases was based on international standards. The consistency of the estimates obtained through the use of different methods and data sources seemed limited. CONCLUSIONS: We successfully identified a conceptual framework for patient safety in acute care including actionable indicators that can be calculated routinely using different data sources at national, regional, and hospital levels. Further work is required to compare methods and understand whether a combination of strategies at national and local levels could be proven effective.

Consistency of safety monitoring using routine national databases: results using a quality of care interpretative model.

BACKGROUND: In the framework of targeted action for continuous safety monitoring, we aimed to evaluate the consistency of indicators derived from available databases for regular reporting. METHODS: We used a quality of care interpretative model to select characteristics from five national databases, aggregated and linked by homogeneous groups of providers. The target population included all subjects admitted to public hospitals for acute care in four regions of Italy between 2011 and 2013. The association between structures, processes and safety-related outcomes was investigated using odds ratios from generalized estimating equations logistic regression. Outcome measures included claims of malpractice and five patient safety indicators calculated from discharge abstracts using standardized algorithms. RESULTS: Over 3 years, claims of malpractice and sepsis increased, whereas deep vein thrombosis and pulmonary embolism decreased. Hospitals with high vs. low volume of discharges were associated with -16% lower rates of claims, but +12% increased risk of sepsis. Compared with research institutes, university clinics had -17% lower rates of claims and -41% cases of dehiscence, with a +32% increased risk of deep vein thrombosis. Local health care authorities recorded -49% deep vein thrombosis, -26% pulmonary embolism, -40% sepsis and +37% risk of claims. Hospitals submitting cases of safe practices and implementing safety recommendations showed significantly higher rates for most outcome measures. CONCLUSIONS: Indicators from regular databases can be conveniently used to develop a national safety monitoring system for hospital care. Although deeper analysis is needed, institutions with a higher propensity to implement safe practices and recommendations consistently showed higher rates of adverse events.