Patient Safety Indicators - Decubitus Ulcer - London 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.

  • Barking, Havering & Redbridge

    Observed: 50

    Expected: 62.9

    Relative Risk: 79.6

  • Barnet & Chase Farm

    Observed: 18

    Expected: 15.0

    Relative Risk: 120.2

  • Barts & the London NHS

    Observed: 7

    Expected: 24.4

    Relative Risk: 28.7

  • Chelsea & Westminster

    Observed: 30

    Expected: 15.6

    Relative Risk: 192.8

  • Croydon

    Observed: 43

    Expected: 34.2

    Relative Risk: 125.8

  • Ealing

    Observed: 16

    Expected: 20.3

    Relative Risk: 79.0

  • Epsom & St Helier

    Observed: 65

    Expected: 29.2

    Relative Risk: 222.7

  • Guy's & St Thomas'

    Observed: 19

    Expected: 46.4

    Relative Risk: 40.9

  • Homerton

    Observed: n/a

    Expected: n/a

    Relative Risk: 94.1

  • Imperial College

    Observed: 55

    Expected: 73.5

    Relative Risk: 74.8

  • King's College

    Observed: 58

    Expected: 44.9

    Relative Risk: 129.3

  • Kingston

    Observed: 26

    Expected: 17.9

    Relative Risk: 145.4

  • Lewisham

    Observed: 21

    Expected: 20.9

    Relative Risk: 100.4

  • Newham

    Observed: 15

    Expected: 6.1

    Relative Risk: 245.5

  • North Middlesex

    Observed: 36

    Expected: 18.6

    Relative Risk: 193.6

  • North West London

    Observed: 75

    Expected: 54.4

    Relative Risk: 137.9

  • Royal Free Hampstead

    Observed: 34

    Expected: 38.2

    Relative Risk: 89.0

  • South London

    Observed: 68

    Expected: 74.5

    Relative Risk: 91.3

  • St George's

    Observed: 36

    Expected: 50.7

    Relative Risk: 71.0

  • Hillingdon

    Observed: 32

    Expected: 19.5

    Relative Risk: 164.1

  • Whittington

    Observed: 15

    Expected: 16.7

    Relative Risk: 89.7

  • University College London

    Observed: 41

    Expected: 33.2

    Relative Risk: 123.5

  • West Middlesex

    Observed: 40

    Expected: 19.2

    Relative Risk: 208.0

  • Whipps Cross

    Observed: 70

    Expected: 35.8

    Relative Risk: 195.7

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
Barking, Havering & Redbridge 50 62.9 4884 79.6 59.0 104.9
Barnet & Chase Farm 18 15.0 2145 120.2 71.2 190.0
Barts & the London NHS 7 24.4 4457 28.7 11.5 59.2
Chelsea & Westminster 30 15.6 1873 192.8 130.1 275.3
Croydon 43 34.2 2577 125.8 91.0 169.4
Ealing 16 20.3 1662 79.0 45.1 128.2
Epsom & St Helier 65 29.2 3526 222.7 171.8 283.8
Guy's & St Thomas' 19 46.4 7459 40.9 24.6 63.9
Hillingdon 32 19.5 1901 164.1 112.2 231.7
Homerton N/A N/A 610 94.1 10.6 339.9
Imperial College 55 73.5 8339 74.8 56.3 97.4
King's College 58 44.9 6080 129.3 98.2 167.2
Kingston 26 17.9 1512 145.4 95.0 213.1
Lewisham 21 20.9 1732 100.4 62.1 153.4
Newham 15 6.1 984 245.5 137.3 405.0
North Middlesex 36 18.6 1581 193.6 135.6 268.0
North West London 75 54.4 4471 137.9 108.4 172.8
Royal Free Hampstead 34 38.2 4276 89.0 61.6 124.4
South London 68 74.5 6386 91.3 70.9 115.7
St George's 36 50.7 5738 71.0 49.7 98.3
University College London 41 33.2 5713 123.5 88.6 167.6
West Middlesex 40 19.2 1476 208.0 148.6 283.2
Whipps Cross 70 35.8 3001 195.7 152.6 247.3
Whittington 15 16.7 1583 89.7 50.2 148.0

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

  • Banding:
  • Low
  • Within expected
  • High
Provider Observed Expected Denominator Relative Risk LCL UCL
East Midlands Strategic Health Authority 452 422.2 39520 107.1 97.4 117.4
East Of England Strategic Health Authority 1094 669.3 58835 163.5 153.9 173.4
London Strategic Health Authority 872 774.1 83966 112.7 105.3 120.4
North East Strategic Health Authority 448 364.0 33752 123.1 111.9 135.0
North West Strategic Health Authority 1274 886.0 85049 143.8 136.0 151.9
South Central Strategic Health Authority 347 367.4 37171 94.4 84.8 104.9
South East Coast Strategic Health Authority 715 489.5 41947 146.1 135.5 157.2
South West Strategic Health Authority 593 720.4 65958 82.3 75.8 89.2
West Midlands Strategic Health Authority 726 669.6 63077 108.4 100.7 116.6
Yorkshire and The Humber Strategic Health Authority 661 674.3 64986 98.0 90.7 105.8

Measure: Decubitus Ulcer Patient Safety Indicator

Description
The ratio of the observed number of cases of decubitus ulcer to the expected number, per all surgical and medical discharges with an operating room procedure.
Definition

Observed: Number of denominator spells with the ICD10 code for decubitus ulcer 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 where length of stay is at least 5 days, 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: All spells with ICD10 code for decubitus ulcer in any secondary field across the spell.

ICD10 code: L89 Decubitus Ulcer

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 and OPCS codes.

See Appendix A: Surgical HRGs. See Appendix B: Medical HRGs. See Appendix C: Derived Operating Room Procedures.

Exclude cases:

  • With length of stay less than 5 days
  • With ICD10 code of decubitus ulcer (see numerator) in the principal diagnosis field
  • Any diagnosis of ICD10 codes for Hemiplegia, paraplegia, quadriplegia, spina bifida or anoxic brain damage across the spell.

ICD10 codes for Hemiplegia, paraplegia, quadriplegia, spina bifida or anoxic brain damage.

ICD10 code Description
G801 Spastic diplegia
G802 Infantile hemiplegia
G808 Other infantile cerebral palsy
G809 Infantile cerebral palsy, unspecified
G810 Flaccid hemiplegia
G811 Spastic hemiplegia
G819 Hemiplegia, unspecified
G822 Paraplegia, unspecified
G825 Tetraplegia, unspecified
G830 Diplegia of upper limbs
G831 Monoplegia of lower limb
G832 Monoplegia of upper limb
G833 Monoplegia, unspecified
G834 Cauda equina syndrome
G838 Other specified paralytic syndromes
G839 Paralytic syndrome, unspecified
N319 Neuromuscular dysfunction of bladder, unspecified
G931 Anoxic brain damage, not elsewhere classified
G939 Disorder of brain, unspecified
G978 Other postprocedural disorders of nervous system

With an OPCS procedure code for debridement or pedicle graft op before or on the same day as the major operating room procedure (surgical cases only):

OPCS code Description
T778 Other specified excision of muscle
S571 Debridement of skin NEC (includes excision of devitalised skin)
S573 Toilet of skin NEC
S17 + Y703 Distant flap of skin &muscle (first stage of staged operations NOC)
S18 + Y703 Distant flap of skin &fascia (first stage of staged operations NOC)
S19 + Y703 Distant pedicle flap of skin (first stage of staged operations NOC)
S24 + Y703 Local flap of skin &muscle (first stage of staged operations NOC)
S25 + Y703 Local flap of skin &fascia (first stage of staged operations NOC)
S26 + Y703 Local pedicle flap of skin (first stage of staged operations NOC)
S17 + Y713 Distant flap of skin &muscle (Revisional operations NOC)
S18 + Y713 Distant flap of skin &fascia (Revisional operations NOC)
S19 + Y713 Distant pedicle flap of skin (Revisional operations NOC)
S24 + Y713 Local flap of skin &muscle (Revisional operations NOC)
S25 + Y713 Local flap of skin &fascia (Revisional operations NOC)
S26 + Y713 Local pedicle flap of skin (Revisional operations NOC)
Admission source (ADMISORC) indicating long-term care
54 NHS run nursing home, residential care home or group home
85 Non-NHS (other than Local Authority) run residential care home (from 1996-97)
86 Non-NHS (other than Local Authority) run nursing home (from 1996-97)
88 non-NHS (other than Local Authority) run hospice
Transferred from acute care facility
Transfer (ADMIMETH=81 or ADMISORC=50-54) where previous trust is acute
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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