Patient Safety Indicators - Accidental Puncture or Laceration - North West 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.

  • Aintree

    Observed: 22

    Expected: 63.9

    Relative Risk: 34.4

  • Blackpool, Fylde & Wyre

    Observed: 25

    Expected: 86.6

    Relative Risk: 28.9

  • Central Manchester

    Observed: 119

    Expected: 71.0

    Relative Risk: 167.6

  • Countess Of Chester

    Observed: 28

    Expected: 54.2

    Relative Risk: 51.6

  • East Cheshire

    Observed: 33

    Expected: 28.1

    Relative Risk: 117.5

  • East Lancashire

    Observed: 92

    Expected: 94.5

    Relative Risk: 97.3

  • Lancashire

    Observed: 156

    Expected: 93.1

    Relative Risk: 167.5

  • Mid Cheshire

    Observed: 50

    Expected: 48.7

    Relative Risk: 102.7

  • North Cumbria

    Observed: 49

    Expected: 58.7

    Relative Risk: 83.5

  • Pennine Acute

    Observed: 68

    Expected: 157.7

    Relative Risk: 43.1

  • Royal Bolton

    Observed: 26

    Expected: 46.8

    Relative Risk: 55.6

  • Royal Liverpool & Broadgreen

    Observed: 46

    Expected: 74.0

    Relative Risk: 62.2

  • Salford Royal

    Observed: 117

    Expected: 59.0

    Relative Risk: 198.3

  • Southport & Ormskirk

    Observed: 26

    Expected: 48.3

    Relative Risk: 53.8

  • St Helens & Knowsley

    Observed: 41

    Expected: 60.0

    Relative Risk: 68.4

  • Stockport

    Observed: 79

    Expected: 59.6

    Relative Risk: 132.6

  • Tameside

    Observed: 21

    Expected: 33.9

    Relative Risk: 62.0

  • Trafford

    Observed: 23

    Expected: 23.2

    Relative Risk: 99.1

  • South Manchester

    Observed: 30

    Expected: 69.6

    Relative Risk: 43.1

  • Morecambe Bay

    Observed: 33

    Expected: 70.7

    Relative Risk: 46.7

  • Warrington & Halton

    Observed: 70

    Expected: 56.8

    Relative Risk: 123.2

  • Wirral

    Observed: 77

    Expected: 71.5

    Relative Risk: 107.8

  • Wrightington, Wigan & Leigh

    Observed: 31

    Expected: 73.5

    Relative Risk: 42.2

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
Aintree 22 63.9 71472 34.4 21.6 52.1
Blackpool, Fylde & Wyre 25 86.6 83154 28.9 18.7 42.6
Central Manchester 119 71.0 76111 167.6 138.9 200.6
Countess Of Chester 28 54.2 54196 51.6 34.3 74.6
East Cheshire 33 28.1 28744 117.5 80.9 165.0
East Lancashire 92 94.5 94018 97.3 78.5 119.4
Lancashire 156 93.1 90753 167.5 142.3 196.0
Mid Cheshire 50 48.7 52142 102.7 76.2 135.4
Morecambe Bay 33 70.7 69415 46.7 32.1 65.6
North Cumbria 49 58.7 58515 83.5 61.8 110.4
Pennine Acute 68 157.7 162923 43.1 33.5 54.7
Royal Bolton 26 46.8 49755 55.6 36.3 81.4
Royal Liverpool & Broadgreen 46 74.0 82129 62.2 45.5 82.9
Salford Royal 117 59.0 62498 198.3 164.0 237.6
South Manchester 30 69.6 70301 43.1 29.1 61.5
Southport & Ormskirk 26 48.3 46987 53.8 35.2 78.9
St Helens & Knowsley 41 60.0 68998 68.4 49.1 92.8
Stockport 79 59.6 61231 132.6 105.0 165.3
Tameside 21 33.9 36885 62.0 38.3 94.7
Trafford 23 23.2 21950 99.1 62.8 148.7
Warrington & Halton 70 56.8 60464 123.2 96.0 155.6
Wirral 77 71.5 74820 107.8 85.0 134.7
Wrightington, Wigan & Leigh 31 73.5 69674 42.2 28.7 59.9

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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