Post on 30-May-2018
Improved quality, improved safety and containing healthcare costs – too good to be true?
Beth Lilja, Executive Director15th European Health Forum
Gastein – October 4th 2012
Danish Society forPatient Safety
Foto: Thomas Dolmer Nielsen
There has never been a more important time to focus on Quality and Safety Improvement in Health Care
Budget deficit
UnemploymentEconomic crisis
Recession
Increasing cost
Increasing complexity
Demographic development
Unacceptable number of adverce events
Rising demand for Healthcare Service
Reference: Collum 1-3 and 5 from National Board of Health
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Danish Society for
Patient Safety
October 4, 2012 4www.patientsikkerhed.dk
New York (1991) 4%
Australia (1994) 13%
UK (2000) 11%
New Zealand (2001) 13%
Denmark (2001) 9%
France (2004) 9%
Canada (2004) 8%
The Netherlands (2007) 6%
Sweden (2008) 9%
Patient Safety – Incidents with harm
Colorado/Utah (1999) 3%
Some facts
• Ageing population
• Increasing complexity
• Increasing cost
• Rising expectation
• Outcomes are not as good as they could be
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Patient Safety
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Number of elderly over the age of 80 increased by nearly 60 pct. from 1980 to 2009
Today: 18 pct. of population +65 years
19602010
6
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Health expenditure as % of BNP
Reference: OECD Health Data 2012
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We must address:
• Waste and inefficiency in healthcare
• Harm caused by healthcare
• Unacceptable clinical variation
• Patient centered care
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Patient Safety
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Patient Safety
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Danish Society for
Patient Safety
67 Wards and units
29% of 2.266 beds 䍜655 beds
What is the size of your nearby hospital?
655 Beds!
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Patient SurveysҮ 10% errors
Reporting system
Chart reviewsҮ 10 - 25% harm
What do we know about harm?
How likely do you think it is that patients could be harmed by a)Hospital care? b)Non-hospital care?
Inner pie: Hospital careOuter pie: Non-hospital careReference: Patient Safety and Quality of Healthcare, Special Eurobarometer 327.
TNS Opinion & Social, Belgium 2010
Danish Society for
Patient Safety
Half of us know the risk
How likely do you think it is that patients could be harmed by a)Hospital care? b)Non-hospital care?
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Dollars
Reference: Health Econ. 2010 Oct 20. Measuring the cost of hospital adverse patient safety events. Carey K, Stefos T.
Min: 5.000 $
Max: 60.000 $
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Patient Safety
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17 years
It takes an estimated average of 17 years for only 14 % of new scientific discoveries to enter day-to-day clinical practice.
Reference: Westfall, J.M, Mold J. & Fagnan L, Practice-based research. ”Blue Highways” on the
NIH roadmap. 2007 JAMA 297(4) p. 403
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Patient Safety
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The Aspirin Example
• In patients who have had a stroke or TIA
aspirin reduces risk by 23%
• 100.000 patients – 23.000 fewer strokes
• 58% of eligible patients receive aspirin =
13.340 fewer strokes
Reference: Wolf et al.: Ann Fam Med 2005;3:545-552
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Patient Safety
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Association between quality and Econoomy
Quality Budget
1 2 3 4 5
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Patient Safety
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Pressure Ulcers
• In 2010 Denmark experienced approx. 1,3
mio. admissions1
• Approx. 19% of the patients had a pressure
ulcer2
• We think half of them got it during their stay
at the hospital
References: 1.Ministry of Health2.Sår, 17. årgang, nr. 4, 2009
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Patient Safety
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October 4, 2012 18Pictures: Ugeskr Læger 2010;172(8):601-606
Degree Have
pressure
ulcer
Got it at the
hospital
# patients
1 Ca. 9% Ca. 4,5% Ca. 62.000
2 Ca. 7% Ca. 3,5 Ca. 45.000
3 Ca. 2% Ca. 1% Ca. 13.000
4 Ca. 1% Ca. 0,5% Ca. 5.000
13.000 pt.
+ 5.000 pt.
= 18.000 pt.
The pressure ulcer results in extra days at the hospital
2 days 4 days 6 days 8 days 10 days
That equals approx.
36.000 days
72.000 days
109.000 days
145.000 days
182.000 days
That equals approx. a hospital with
100 beds
200 beds
300 beds
400 beds
500 beds
182.000 days equals a medium size hospital in Denmark for a year.
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Danish Society for
Patient Safety
182.000 days in Denmark 䍜 500 bed hospital
182.000 days in hospital in Denmark 䍜 16.000.000 days in hospital in Europe
16.000.000 days in hospital in Europe 䍜 44.000 bed hospital
We have approx. 20.000 hospital beds in Denmark!
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Reference: Hamish Laing, april 2012
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4 October 2012
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Patient Safety
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Scotland - 0 CVK-infections
0
0.5
1
1.5
2
2.5
3
3.5
4
Jan-08
Apr-08
Jul-08
Oct-08
Jan-09
Apr-09
Jul-09
Oct-09
Jan-10
Apr-10
Jul-10
Oct-10
Jan-11
Apr-11
Jul-11
Oct-11
0.84
2.870% reduction
Reference: Scottish Patient Safety Programme, Marts 2012
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Patient Safety
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0
0,5
1
1,5
2
2,5
3
3,5
UVI
NLVI
DPSI
BAK/SEP
Prevalence of Hospital Acqired
Infections in Denmark
Reference: CEI-NYT www.ssi.dk
254 October 2012
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Patient Safety
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The Danish Safer Hospital Programme Aims and intermediate aims
• Mortality (HSMR) 15% ����
• Harm (Gobal Trigger Tool) 30% ����
– Cardiac arrest 30% �
– Central line infections 0
– Ventilator associated pneumonia 0
– Pressure ulcers 50% �
– Readmissions after heart failure < 10%
– Postoperative mortality 20% �
– Postoperative readmissions 20% �
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Patient Safety
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CVK-insertion Bundle
2010-11 2011-02 2011-05 2011-08 2011-12 2012-03 2012-0675%
80%
85%
90%
95%
100%
CVK-anlæggelser med alle elementer opfyldt, Intensiv Afdeling, Kolding
Måned
Procent
Month
% CVK Bundle with full compliance, ICU, Kolding Hospital
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CVK-indication
2010-12 2011-03 2011-06 2011-09 2012-01 2012-04 2012-070%
20%
40%
60%
80%
100%
CVK'er med relevant indikation, Intensiv Afdeling, Kolding
Måned
Procent
Month
CVK with relevant indication, ICU, Kolding Hospital
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Days between CVK-infections
2010-02-02
2010-02-15
2010-02-20
2010-04-01
2010-04-09
2010-05-06
2010-12-10
2010-12-22
2010-12-22
2010-12-31
2011-02-06
2011-03-05
2011-07-10
2012-09-08
0
100
200
300
400
500
Dage mellem CVK-infektioner, Intensiv Afdeling, Kolding
Dato
Dage
Month
Days
Days between CVK-infections, ITU, Kolding Hospital
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What does it take?• Bold aims – How much by when?
• Measurement strategy – How do we know that
we are moving forward?
• Theory on how to get there
• Stick to an improvement method – Capability
and capacity building
WILL - IDEA - EXECUTION
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Reference: Ministry of Health, Sundhedsøkonomi, Dok. Nr. 732202 and Sundhed.dk
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Den behårede arm
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4 October 2012