Vol 7: Perioperative patient safety indicators and hospital surgical volumes.Report as inadecuate



 Vol 7: Perioperative patient safety indicators and hospital surgical volumes.


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This article is from BMC Research Notes, volume 7.AbstractBackground: Since the late 1990s, patient safety has been an important policy issue in developed countries. To evaluate the effectiveness of the activities of patient safety, it is necessary to quantitatively assess the incidence of adverse events by types of failure mode using tangible data. The purpose of this study is to calculate patient safety indicators PSIs using the Japanese Diagnosis Procedure Combination-per-diem payment system DPC-PDPS reimbursement data and to elucidate the relationship between perioperative PSIs and hospital surgical volume. Methods: DPC-PDPS data of the Medi-Target project managed by the All Japan Hospital Association were used. An observational study was conducted where PSIs were calculated using an algorithm proposed by the US Agency for Healthcare Research and Quality. We analyzed data of 1,383,872 patients from 188 hospitals who were discharged from January 2008 to December 2010. Results: Among 20 provider level PSIs, four PSIs three perioperative PSIs and decubitus ulcer and mortality rates of postoperative patients were related to surgical volume. Low-volume hospitals less than 33rd percentiles surgical volume per month had higher mortality rates 5.7%, 95% confidence interval CI, 3.9% to 7.4% than mid- 2.9%, 95% CI, 2.6% to 3.3% or high-volume hospitals 2.7%, 95% CI, 2.5% to 2.9%. Low-volume hospitals had more deaths among surgical inpatients with serious treatable complications 38.5%, 95% CI, 33.7% to 43.2% than high-volume hospitals 21.4%, 95% CI, 19.0% to 23.9%. Also Low-volume hospitals had lower proportion of difficult surgeries 54.9%, 95% CI, 50.1% to 59.8% compared with high-volume hospitals 63.4%, 95% CI, 62.3% to 64.6%. In low-volume hospitals, limited experience may have led to insufficient care for postoperative complications. Conclusions: We demonstrated that PSIs can be calculated using DPC-PDPS data and perioperative PSIs were related to hospital surgical volume. Further investigations focusing on identifying risk factors for poor PSIs and effective support to these hospitals are needed.



Author: Kitazawa, Takefumi; Matsumoto, Kunichika; Fujita, Shigeru; Yoshida, Ai; Iida, Shuhei; Nishizawa, Hirotoshi; Hasegawa, Tomonori

Source: https://archive.org/







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