Patient Safety Indicators - Accidental Puncture or Laceration - East Of England 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.

  • Basildon & Thurrock

    Observed: 64

    Expected: 54.0

    Relative Risk: 118.5

  • Bedford Hospital

    Observed: 19

    Expected: 36.9

    Relative Risk: 51.5

  • Cambridge

    Observed: 194

    Expected: 113.4

    Relative Risk: 171.1

  • Colchester

    Observed: 40

    Expected: 53.3

    Relative Risk: 75.1

  • East & North Hertfordshire

    Observed: 38

    Expected: 71.1

    Relative Risk: 53.4

  • Hinchingbrooke

    Observed: 41

    Expected: 32.8

    Relative Risk: 124.9

  • Ipswich

    Observed: 80

    Expected: 68.1

    Relative Risk: 117.4

  • James Paget

    Observed: 56

    Expected: 44.9

    Relative Risk: 124.6

  • Luton & Dunstable

    Observed: 66

    Expected: 49.6

    Relative Risk: 133.2

  • Mid Essex

    Observed: 126

    Expected: 70.3

    Relative Risk: 179.2

  • Norfolk & Norwich

    Observed: 124

    Expected: 131.4

    Relative Risk: 94.3

  • Peterborough & Stamford

    Observed: 80

    Expected: 62.2

    Relative Risk: 128.5

  • Southend

    Observed: 106

    Expected: 80.5

    Relative Risk: 131.7

  • Princess Alexandra

    Observed: 56

    Expected: 52.2

    Relative Risk: 107.3

  • Queen Elizabeth King's Lynn

    Observed: 15

    Expected: 59.9

    Relative Risk: 25.1

  • West Hertfordshire

    Observed: 100

    Expected: 60.2

    Relative Risk: 166.0

  • West Suffolk

    Observed: 84

    Expected: 43.1

    Relative Risk: 194.9

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
Basildon & Thurrock 64 54.0 53409 118.5 91.2 151.3
Bedford Hospital 19 36.9 35965 51.5 31.0 80.4
Cambridge 194 113.4 104811 171.1 147.8 196.9
Colchester 40 53.3 55072 75.1 53.6 102.2
East & North Hertfordshire 38 71.1 70826 53.4 37.8 73.3
Hinchingbrooke 41 32.8 29946 124.9 89.6 169.5
Ipswich 80 68.1 64581 117.4 93.1 146.2
James Paget 56 44.9 42772 124.6 94.1 161.8
Luton & Dunstable 66 49.6 48889 133.2 103.0 169.4
Mid Essex 126 70.3 69004 179.2 149.3 213.4
Norfolk & Norwich 124 131.4 121824 94.3 78.5 112.5
Peterborough & Stamford 80 62.2 59831 128.5 101.9 160.0
Princess Alexandra 56 52.2 50729 107.3 81.1 139.4
Queen Elizabeth King's Lynn 15 59.9 54571 25.1 14.0 41.3
Southend 106 80.5 74202 131.7 107.8 159.2
West Hertfordshire 100 60.2 58786 166.0 135.1 201.9
West Suffolk 84 43.1 41089 194.9 155.5 241.3

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

Description:
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.
Definition:

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
Basis
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.
Notes

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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