Patient Safety Indicators - Accidental Puncture or Laceration - South Central SHA

Relative Risk with 95% and 99.8% control limits

Select Acute Trust... Basingstoke & North Hampshire Buckinghamshire Heatherwood & Wexham Park Isle Of Wight Milton Keynes Oxford Radcliffe Portsmouth Royal Berkshire Southampton Winchester & Eastleigh

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

• Basingstoke & North Hampshire

  Observed: 21

  Expected: 35.1

  Relative Risk: 59.8

• Buckinghamshire

  Observed: 61

  Expected: 68.8

  Relative Risk: 88.7

• Heatherwood & Wexham Park

  Observed: 29

  Expected: 54.1

  Relative Risk: 53.6

• Isle Of Wight

  Observed: 11

  Expected: 16.3

  Relative Risk: 67.4

• Milton Keynes

  Observed: 77

  Expected: 38.5

  Relative Risk: 200.2

• Oxford Radcliffe

  Observed: 150

  Expected: 123.1

  Relative Risk: 121.8

• Portsmouth

  Observed: 54

  Expected: 92.8

  Relative Risk: 58.2

• Royal Berkshire

  Observed: 101

  Expected: 69.6

  Relative Risk: 145.0

• Southampton

  Observed: 116

  Expected: 85.0

  Relative Risk: 136.5

• Winchester & Eastleigh

  Observed: 40

  Expected: 33.1

  Relative Risk: 120.8

Relative Risk with 95% and 99.8% control limits

• Banding:
• Low
• Within expected
• High

Select Acute Trust... Basingstoke & North Hampshire Buckinghamshire Heatherwood & Wexham Park Isle Of Wight Milton Keynes Oxford Radcliffe Portsmouth Royal Berkshire Southampton Winchester & Eastleigh

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.

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

• Banding:
• Low
• Within expected
• High

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).