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

Danish Society for

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

Danish Society for

Patient Safety

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Danish Society for

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 $

Danish Society for

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

Danish Society for

Patient Safety

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Association between quality and Econoomy

Quality Budget

1 2 3 4 5

Danish Society for

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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Danish Society for

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