PATIENT SAFETY TOOLS USED IN REGIONAL SLOVAK HOSPITALS

1. Trnava Universityin Trnava, Slovakia FACULTY OF HEALTH SCIENCES AND SOCIAL WORK DEPARTMENT OF PUBLIC HEALTH PATIENT SAFETY TOOLS USED IN REGIONAL SLOVAK HOSPITALS prof Viera Rusnáková, MD, PhD, MBA Katarína Naďová, MD 25.04.2014

2. BACKROUND • Improving quality and safety of healthcare is frequently declared objective of all stakeholders in any health care system • Patient safety has become natural part of evaluation of hospital performance indicators, which represent a challenge for creation of health policies and initiatives in European countries (e.g. OECD) • Patient safety effort links new technologies, management tools (safety audits), as well as appropriate evaluation of culture in health care organizations, however • Multi professional cooperation and education is needed for achieving progress in PS • Decentralized approach is possible if country/national level initiatives are not sufficient

3. OBJECTIVES The aim of the contribution is to emphasize the issue of patient safety (PS) in hospitals and to demonstrate initiatives of hospitals within the Trnava Region in collaboration with the Faculty of HS and SW TU Results from patient safety culture (PSC) survey, evaluation of selected PATH - EU indicators and utilization of PS audit as proposed by the WHO willbepresented.

4. Trnava County

5. MethodS

6. Patient safety culture survey • The survey was conducted in three hospitals in Trnava Region using AHRQ questionnaire "The hospital survey on patient safety culture”. • The target population was created by 1,787 health workers from all hospital departments. RR was 75% (1,341 respondents). 36 questionnaires were excluded during evaluation (based on not relevant / negative responses). • Statistical data processing: • Basic descriptive statistics • correlations mixed model linear regression, chi-square test and paired proportional test at significance level of p ≤ 0.05. • Cronbach's alpha test was used to analyze the compatibility of the respondents' answers and to verify the validity of the questionnaire used Slovak version

7. Assessment of quality/safety indicators • Search for available indicators from WHO PATH- EU project set was conducted in tree hospitals and suitable data from patients electronic health records in one hospital database MEDEAwere collected • Retrospective data for the period 2009 to 2011 were analyzed from one hospital • Statistical data processing: • basic descriptive statistics and stratification • Kolmogorov-Smirnov and Shapiro-Wilk test, a simple independent t - test, linear regression and Pearson correlation (p ≤ 0.05) • boxplots, cumulative graphs For statistical analysis of the data was used in the work program SPSS 13.0 and R-project 2.3.7.1.

8. Analyzed PATH indicators • C – section rate • Length of stay and • Patient based 30 days mortality in-hospital • Inguinal hernia: ICD-10: K40 • Stroke: ICD-10: I61, I62, I63, I64 • Acute Myocardial Infarction (AMI): ICD-10: I21, I22 • Community acquired pneumonia: ICD-10: J15, J18 (J13, J14,A48.1 were not occurred)

9. Patient safety audit • WHO PS audit for adverse events was piloted in two hospitals at departmental level • Neurology - 100 patient records and • Urology – 50 patient records assessed • February- March 2013 • In collaboration with PH students and hospital epidemiologist • Reporting system for hospital acquired infection was analyzed in parallel

10. Patient safety culture survey Interview AHRQ Results I.

11. 12 dimensions AHRQ PSC in Slovak Hospitals (2011) -- Comparison with the USA survey (2009) Data are in % *P-value ≤ 0.05 ** P-value ≤ 0.01 *** P-value ≤ 0.001

12. Comparison of views MDs and nurses - 12 dimensions of safety culture questionnaire AHRQ

13. Reporting system Number of events that were reported in the last 12 months – international comparison Data are in %

14. PATH sets of quality indicators Results II.

15. LOS and 30 days mortality for selected diagnosis * P ≤ 0.05, ** p ≤ 0.01. *** P ≤ 0.001 ( independent sample t - test)

16. Results III. Incidence of adverse events was • 9% (CI 95% 4 - 16%) atneurologydept. eventually • 4% (CI 95% 0,64 – 11,91%) aturology dept. from restricted sample (100 eventually 53) of medical records audited. Adverse events were connected with longer LOS (p<0,001) and in 50 % were preventable, but several limitations of retrospective methods was revealed.

17. SUMMARY Despite limitations of presented studies it is evident that: • Analysis of selected indicators demonstrated • No significant differences in the quality of provision of health care in general but • insufficient quality of data for routine analysis • Problems are in culture of patient safety • The issue is reporting systems and mutual communication, non punitive response to adverse events, role of management

18. SUMMARYcont. • Challenges for hospital managements are in • Use of guidelines and tools for assessing risk patients • Definition of responsibility for quality and safety especially for HAI • Improving HIS and meaningful use of HER for performance assessment • Academy could play significant role in the improvement of • Education and training of hospital staff • Providing capacities for research • Common conferences and campaigns – egg Hand hygiene, Surgical check list,… • Culture change support – increase maturity especially in patient safety culture

19. CONCLUSION – ULTIMATE CHANGE IS NEEDED Information is actively searched Reporting persons are trained Competences are set up Errors are analyzed systematically New ideas are welcome Information is confidential and unused Providers of information are punished Nobody accepts responsibility Errors are not explained New ideas are repressed

20. "Our effort is not about trying to shame or blame, it's about improving health care” (Canadian Patient Safety Institute, 2012).

21. THANK YOU FOR YOUR ATTENTION