Measuring harm in healthcare

Our demographics are changing…

Our tolerance is changing….

The burden is growing…….

Measurement is complex

Hospital Episode Statistics Mortality (in hospital) Length of in-patient stay 30 day Readmission Decubitus ulcer VTE

http://www.nrls.npsa.nhs.uk/ http://www.nrls.npsa.nhs.uk/resources/?EntryId45=135153

Are we improving?

The 6 million dollar question

MRSA Infection Rates

MRSA All England Rate per 1,000 Bed Days

u' chart

Set 5: UCL = 0.02, CTL = 0.01, LCL = 0.00 (51 - 70) (Lloyd Nelson option) Inspected Mean = 3,041.33, Counts Mean = 33.94

0.10

0.09

0.08

UCL

0.07 to 0.01 per 1000 bed days = 86%

 0.07

CTL 0.06

0.05

LCL UCL 0.04

CTL UCL 0.03

LCL CTL 0.02

LCL UCL CTL UCL LCL CTL 0.01

LCL 0.00

01 /0 4/ 20 07 01 /0 7/ 20 07 01 /1 0/ 20 07 01 /0 1/ 20 08 01 /0 4/ 20 08 01 /0 7/ 20 08 01 /1 0/ 20 08 01 /0 1/ 20 09 01 /0 4/ 20 09 01 /0 7/ 20 09 01 /1 0/ 20 09 01 /0 1/ 20 10 01 /0 4/ 20 10 01 /0 7/ 20 10 01 /1 0/ 20 10 01 /0 1/ 20 11 01 /0 4/ 20 11 01 /0 7/ 20 11 01 /1 0/ 20 11 01 /0 1/ 20 12 01 /0 4/ 20 12 01 /0 7/ 20 12 01 /1 0/ 20 12 01 /0 1/ 20 13 Month Data sourced from the Health Protection Agency (mandatory surveillance of MRSA, Trust apportioned cases based on 167 NHS Acute Trusts in England) and HES online (calculated hospital bed days), calculated for the period April 2007 – October 2012. The data is presented as a rate (U Prime Chart) of MRSA bacteraemia per 1,000 hospital bed days (based on HES number of episodes). The mean rate for the latest re-based period is 0.01 per 1,000 FCE’s, an 86% decrease from the first period centre line. During the reported period there has been a decrease (before and after, first (Aug-Oct) and last three data points) of 2,558,522 bed days.

C.Diff Infection Rates

C.Diff All England Rate per 1,000 Bed Days

u' chart

Set 5: UCL = 0.20, CTL = 0.17, LCL = 0.15 (56 - 70) (Lloyd Nelson option) Inspected Mean = 3,006.32, Counts Mean = 521.75

1.2

0.3

0.2

0.1

0.0

1.1

1.0

UCL 0.9

0.8

CTL 0.7

0.6

LCL 0.5

0.4

UCL CTL LCL UCL CTL LCL

0.79 to 0.17 per 1000 bed days = 78%

 UCL CTL LCL UCL CTL LCL Month Data sourced from the Health Protection Agency (mandatory surveillance of Clostridium Difficile, Trust apportioned cases based on 167 NHS Acute Trusts in England) and HES online (calculated hospital bed days), calculated for the period April 2007 – October 2012. The data is presented as a rate (U Prime Chart) of C.Diff per 1,000 hospital bed days (based on HES number of episodes). The mean rate for the latest re based period is 0.17 per 1,000 FCE’s, a 75% decrease from the first period centre line. During the reported period there has been a decrease (before and after, first (Aug-Oct) and last three data points) of 2,558,522 bed days.

The proportion of patients who die in hospital Seasonal Adjustment 19%



1.88% 1.52%

Months Data sourced from Hospital Episode Statistics (HES) for the period April 2007 – October 2012. The data is presented in proportion (p prime chart) of patients in England that die within hospital (both emergency and elective), excluding non-elective/non-emergency e.g. maternity and blank codes. The denominator is the number of hospital admissions. The mean crude rate for the latest rebased period is 1.51%, although this does not take into account seasonal peaks. This data does not highlight the wide variation in mortality rates between organisations. During the reported period monthly admissions have remained stable at approximately 1 million per month. However between 2007 (Aug-Oct) and 2012 (Aug-Oct) there has been an increase in admission of 15% (a difference of 427,691).

The proportion of patients who die in hospital – NHS QUEST network

Data sourced from Hospital Episode Statistics (HES) for the period April 2007 – October 2012. The data is presented in proportion (p prime chart) of patients in England that die within hospital (only emergency admissions), excluding non-elective/non-emergency e.g. maternity and blank codes. The denominator is the number of hospital admissions.

QIPP Safe Care

What about these harms?

200000 180000 160000 140000 120000 100000 80000 60000 40000 20000 0 Q1

Submissions of data in the NHS Safety Thermometer

Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Pre-work

Safety Express

Policy CQUIN CQUIN implemented 700 600 500 400 300 200 100 0

Scale up to a national data collection

How many patients have a pressure ulcer?

How many people have a new pressure ulcer?

Is there a difference between settings?

What category is causing the highest burden?

How much variation is there?

Hospital Group New Pressure Ulcers Number of patient affected by a New Pressure

Organisation

(Cat 2-4)

Incident Reporting Safety Thermometer**

Number of patient affected by New Pressure Ulcer (Cat 3-4 only)

Incident Reporting Safety Thermometer

The Newcastle Upon Tyne Hospitals NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation Trust Central Manchester University Hospitals NHS Foundation Trust Oxford University Hospitals NHS Trust Imperial College Healthcare NHS Trust Cambridge University Hospitals NHS Foundation Trust University College London Hospitals NHS Foundation Trust Guy's and St Thomas' NHS Foundation Trust *** King's College Hospital NHS Foundation Trust University Hospitals Birmingham NHS Foundation Trust

800 243 842 248 22* 153 222 80 147 501* 1844 2098 1215 1948 1041 629 428 613 1328 266 -- -- -- -- -- -- -- -- -- -- 491 270 273 209 38 55 142 68 189 ---

Percentage of patients affected by a New Pressure Ulcer (Cat 2-4)

Incident Reporting Safety Thermometer 0.6% 0.2% 0.6% 0.2% 0.0% 0.2% 0.3% 0.1% 0.2% 0.7% 1.4% 1.6% 0.9% 1.6% 0.8% 0.6% 0.5% 0.6% 1.3% 0.3%

Percentage of patients affected by a New Pressure Ulcer (Cat 3-4 only)

Incident Reporting Safety Thermometer -- -- -- -- -- -- -- -- -- -- 0.4% 0.2% 0.2% 0.2% 0.0% 0.1% 0.2% 0.1% 0.2% -- * Cat 2 Pressure Ulcers not included * Cat 1 Pressure Ulcers included ** Extrapolated figures based on full years HES (2011/12) admissions (inpatient spells) for Shelford group organisations and NHS ST national data for financial year 2012/13 *** Community reporting of pressure ulcers is proportionally higher than Acute reporting (Acute 80 & Community 717) -- No data available

What does all of this really mean?

186, 617

People harmed from pressure ulcers developing

in Hospital in

England alone

149, 293

Could be avoided

No national reduction in 2012…

Commit to Act Now

Tweet ideas #notonmywatch

What are we learning from the evaluation?

Issues common to data collection systems: • • • Connection to purpose Data collection systems Use of data

http://harmfreecare.org

Thank you