Patient Safety Indicators - Accidental Puncture or Laceration - East Midlands SHA

The enhanced version of Dr Foster Intelligence's Real Time Monitoring (RTM) tool now features additional Patient Safety Indicators (PSIs) and service line indicators from the 2010 Hospital Guide. These indicators enable the monitoring and identifying of potential instances of patient harm. The new PSIs were developed by the Agency for Healthcare Research and Quality (AHRQ) in the United States and translated by the Dr Foster Unit at Imperial College London and in conversation with other leading indicator developments units. The methodologies for these indicators were also made available pre-Hospital Guide publication for comment and consultation, in partnership with HSJ last summer.

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Relative Risk with 95% and 99.8% control limits

X-axis: Expected Events, Y-axis: Relative Risk.

  • Chesterfield Royal

    Observed: 44

    Expected: 52.7

    Relative Risk: 83.5

  • Derby

    Observed: 136

    Expected: 123.5

    Relative Risk: 110.1

  • Kettering

    Observed: 41

    Expected: 53.5

    Relative Risk: 76.6

  • Northampton

    Observed: 47

    Expected: 70.4

    Relative Risk: 66.8

  • Nottingham

    Observed: 283

    Expected: 139.0

    Relative Risk: 203.6

  • Sherwood Forest

    Observed: 121

    Expected: 60.7

    Relative Risk: 199.2

  • Lincolnshire

    Observed: 120

    Expected: 125.0

    Relative Risk: 96.0

  • Leicester

    Observed: 77

    Expected: 50.0

    Relative Risk: 154.1

Relative Risk with 95% and 99.8% control limits

  • Banding:
  • Low
  • Within expected
  • High

Caveat: Due to variations in secondary diagnosis coding it is difficult to know what the true national picture is, as some trusts are better at recording the information than others. The data is presented in this analysis in terms of 'High', 'Low' and 'Within expected' but it should be noted that a Trust labelled as 'High' may not actually have higher rates of incidents but are simply better at recording what happens.

Provider Observed Expected Denominator Relative Risk LCL UCL
Chesterfield Royal 44 52.7 54056 83.5 60.7 112.1
Derby 136 123.5 117306 110.1 92.4 130.3
Kettering 41 53.5 54652 76.6 55.0 104.0
Leicester 77 50.0 53121 154.1 121.6 192.7
Lincolnshire 120 125.0 122202 96.0 79.6 114.8
Northampton 47 70.4 67015 66.8 49.0 88.8
Nottingham 283 139.0 145961 203.6 180.6 228.8
Sherwood Forest 121 60.7 61152 199.2 165.3 238.0

Relative Risk with 95% and 99.8% control limits - SHA data

  • Banding:
  • Low
  • Within expected
  • High
SHA Observed Expected Denominator Relative Risk LCL UCL
East Midlands 869 674.8 675465 128.8 120.4 137.6
East Of England 1289 1084.1 1036307 118.9 112.5 125.6
London 1441 1369.3 1474962 105.2 99.9 110.8
North East 789 672.1 683390 117.4 109.3 125.9
North West 1262 1503.3 1547135 83.9 79.4 88.7
South Central 660 616.4 623840 107.1 99.1 115.6
South East Coast 797 758.5 761196 105.1 97.9 112.6
South West 1666 1172.8 1121010 142.1 135.3 149.0
West Midlands 742 1090.9 1108775 68.0 63.2 73.1
Yorkshire and The Humber 823 1121.0 1144770 73.4 68.5 78.6

Measure: Accidental Puncture or Laceration Patient Safety Indicator

The ratio of the observed number of cases of accidental cut, puncture, perforation or laceration to the expected number, per all surgical and medical discharges.

Observed: Number of denominator spells with the ICD10 code for a accidental cut, puncture, perforation or laceration in any secondary field across the spell

Expected: The expected number of observed spells

Denominator: All surgical and medical spells in patients aged 19 and over, subject to certain exclusions.

Relative Risk: The observed numerator divided by the expected (multiplied by 100)

LCL: Lower 95% confidence limit

UCL: Upper 95% confidence limit

Banding: High - high number of observed events recorded (lower 95% confidence limit is greater than 100), Low - low number of observed events recorded (upper 95% confidence limit is lower than 100); Within Expected Range - as expected number of events recorded.

Technical definition

Observed: Discharges among cases meeting the inclusion and exclusion rules for the denominator with ICD10 code denoting accidental cut, puncture, perforation or laceration during a procedure in any secondary diagnosis field across the spell. ICD10 Unintentional cut, puncture, perforation or haemorrhage during surgical and medical care:

ICD code Description
Y600 During surgical operation
Y601 During infusion or transfusion
Y602 During kidney dialysis or other perfusion
Y603 During injection or immunization
Y604 During endoscopic examination
Y606 During aspiration, puncture and other catheterization
Y605 During heart catheterization
Y607 During administration of enema
Y608 During other surgical and medical care
Y609 During unspecified surgical and medical care
T812 Accidental puncture and laceration during a procedure NEC

Expected: The expected value for this indicator, calculated using a logistic regression model which adjusts for a variety of case-mix factors:

  • Admission method
  • Age group (5 year bands)
  • Co-morbidities (based on the Charlson Score of the secondary diagnosis codes)
  • Deprivation (Carstairs quintile)
  • Sex

Denominator: All surgical and medical spells in patients aged 19 and over, defined by specific HRG codes. See Appendix A: Surgical HRGs, See Appendix B: Medical HRGs

Exclude cases

  • Primary diagnosis denoting accidental cut, puncture, perforation or laceration
  • Pregnancy, childbirth and puerperium: defined by the following HRG codes:
HRG Description
N06 Normal Delivery w cc
N07 Normal Delivery w/o cc
N08 Assisted Delivery w cc
N09 Assisted Delivery w/o cc
N10 Caesarean Section w cc
N11 Caesarean Section w/o cc
N12 Antenatal Admissions not Related to Delivery Event
M09 Threatened or Spontaneous Abortion
M10 Surgical Termination of Pregnancy
M11 Medical Termination of Pregnancy
NHS Acute (non-specialist) Trusts
Data sources & Time frame

February 2010 - January 2011

Secondary Uses Services (SUS) Commissioning Data set - non frozen SUS extract.

Data licence acknowledgments
Secondary Uses Services (SUS) - Hospital Admitted Patients - Copyright: Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.

Based on AHRQ PSI indicators.

Translated by the Dr Foster Unit at Imperial College in collaboration with the Care Quality Commission (formerly the Healthcare Commission).

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