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Luc Van Looy
  Medical Director
   GZA Hospitals
 Antwerpen, Belgium
THE PATIENT SAFETY PLAN
OF THE BELGIAN FEDERAL
GOVERNMENT
Patient safety

• Quality of care:
   •   Patient-centered
   •   Accessible
   •   Accurate
   •   In time
   •   Effective
   •   Efficient
   •   Affordable
   •   Safe
Patient safety

• Damage can have many faces and can hit all of
  us
• Reports IOM:
  • 1999 „To err is human‟
  • 2001 „Crossing the quality chasm‟
• Targeting the system, not the individual
• “Events” (adverse events, near misses)
• Safety culture
Patient safety in Belgium
Federal Government project
• 5 year project
  2007-2012
• Funding:
   • National budget 7.216.214 € / year
   • 104 € / hospital bed
   • Hospitals with <100 beds: 10.000 €.
• Free participation, but with engagement
Engagement from the hopitals

• Installing:
   • A central steering patient-safety-committee
   • An operational patient-safety-team
• Implementation of a safety-management-system:
   •   Event notification
   •   Analysis
   •   Improvement actions
   •   Follow-up (indicators)
   •   Paving the way for future aggregation:
        • Uniformity of data
        • Classification  taxonomy
5 year plan



                                                                                                                                                                                               2013-
                          2007                          2008                       2009                      2010         2011                       2012                                      2016
strategy, vision,




                                                                                                                                                                          }
                                            define
    targets
                                                                                                                                                                               integrated
 safety culture                         measurement                                actions for improvement              measurement           actions for improvement         patient safety
     event                                                                                                                                                                    management
                    Preparation                                  installation of notification system                use of notification system in all Belgian hospitals
  notification                                                                                                                                                                   system      In preparation
                     of project
    analysis                                                                             retrospective                          retrospective + proactive
 improvement                                define                                   intramural processes                         extramural processes

                                                                                                                      development new         standardized, integrated,
   indicators                     pilot (only acute hospitals)                            cartography
                                                                                                                         indicators             multidimensional set
Response of the field

                                   97   98
             90      91   91
100

 90   80

 80

 70

 60                                          2007-2008
 50                                          2008-2009
 40                                          2009-2010
 30

 20

 10

  0
       % hospitals             % beds
FOCUS ON TAXONOMY
Why taxonomy?

• Prime target: aggregation of data
  • Study and analysis of data-collections:
     • Detection of patterns and trends
     • Sharing, structuring and communicating available knowledge
     • Quality surveillance
  • Different levels:
     • Hospital
     • Between hospitals:
         Regional network
         National
         International
     • Specialisms (Netherlands: Neosafe, Prima-RT)
Conditions for success

• Clear, understandable and reproducible
• Good balance between:
  • Sufficient detail – specificity
  • Ease of use: limited training must suffice ( ICD9)
• On implementation:
  • Minimal negative impact on existing systems
  • Comparative benefits  buy-in
     • Efficient
     • User-friendly
     • Broad application:
         Acute hospital, psychiatric institution, rehabilitation
            center…
         In-hospital as well as ambulatory care
Taxonomy JCAHO
Taxonomy WHO

• ICPS

 International
 Classification
 for Patient Safety
ICPS: a conceptual framework

                   • 10 high level
                     classes
                   • 48 key concepts
                   • ± 700 concepts
ICPS head classes

    Incident type
    Incident characteristics

    Outcome patient
    Outcome organization

    Patient characteristics

    Detection

    Contributing factors
    Mitigating factors
    Ameliorating actions

    Actions taken to reduce risk
Terrifying at first glance…
ICPS head classes

    Incident type
    Incident characteristics
                                   Minimal dataset
    Outcome patient
    Outcome organization

    Patient characteristics

    Detection

    Contributing factors           Optional
    Mitigating factors
    Ameliorating actions

    Actions taken to reduce risk
Application of taxonomy

• The person reporting an event
• The patient-safety coordinator
• The patient-safety team

• The person reporting an event has no benefit in
  taxonomy
• Even with a minimal dataset, there is always
  ballast for someone somewhere
• Tailoring the notification system to the local
  needs is crucial
Tailoring the notification system
Incorporation in event-notification
Fitting the taxonomy to the Belgian
situation
• Translation: Dutch, French, German
• Defining a code:
  • E:     Wrong patient
    D:     Verkeerde patiënt
    F:     Patient erroné
    G:     Falscher Patient
  • Unique hierarchical code
Translations and codes
Basis for aggregation
Fitting the taxonomy to the Belgian
situation
• Federal Government provides a uniform XML-
  model for data-export
Reporter           Team PatSaf       Team PatSaf            Repository
    • Input incident (±   • Supplementary   • Complete            • Reporting
      taxonomy)             info?             taxonomy            • (Export)
    • Nominative or       • Analysis if       (at least minimal
      anonymous             needed            data set)
                                            • Anonimisation




Decentral point of expertise                                            xml
• Analysis if needed
                                            Committee PatSaf
Problems to solve

• Clarification of some topics:
   • i.e. ambulatory versus in-hospital care
• Consistency with and linking to existing
  classifications:
   • Some are obvious: ICD, ATC, ICF…
   • But others are not and there is not always
     consistency between countries
   • WHO
Problems to solve

• Parallel registrations:
   • Mandatory:
       •   Transfusion-incidents
       •   Tissue donation (bone, tympano-ossicular, skin, veins, …)
       •   Infections
       •   …
   • Others:
       •   Psychiatry
       •   Fall incidents
       •   Radiotherapy
       •   Solitary initiatives…

   • Avoid duplication
   • Integration
Problems

• Legal protection for notification systems
  • Patient safety act (Denmark)
  • Netherlands
  • …
• Safety culture:
  •   Health-workers
  •   Organizations
  •   Patient
  •   Society
      are they all ready for open communication and
      management?
Belgian patient safety project

• ICPS is not officially released by the WHO yet
• Whish for integration as a standard in Belgian
  hospitals
• WHO:
  • Request for a use-case in the Belgian hospital-
    setting
     Applying the minimal dataset to patient-safety
    events
     Coding
     XML-export
     Aggregation of data

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Validating the International Classification for Patient Safety (ICPS): The Belgian Experience

  • 1. Luc Van Looy Medical Director GZA Hospitals Antwerpen, Belgium
  • 2. THE PATIENT SAFETY PLAN OF THE BELGIAN FEDERAL GOVERNMENT
  • 3. Patient safety • Quality of care: • Patient-centered • Accessible • Accurate • In time • Effective • Efficient • Affordable • Safe
  • 4. Patient safety • Damage can have many faces and can hit all of us • Reports IOM: • 1999 „To err is human‟ • 2001 „Crossing the quality chasm‟ • Targeting the system, not the individual • “Events” (adverse events, near misses) • Safety culture
  • 5. Patient safety in Belgium Federal Government project • 5 year project 2007-2012 • Funding: • National budget 7.216.214 € / year • 104 € / hospital bed • Hospitals with <100 beds: 10.000 €. • Free participation, but with engagement
  • 6. Engagement from the hopitals • Installing: • A central steering patient-safety-committee • An operational patient-safety-team • Implementation of a safety-management-system: • Event notification • Analysis • Improvement actions • Follow-up (indicators) • Paving the way for future aggregation: • Uniformity of data • Classification  taxonomy
  • 7. 5 year plan 2013- 2007 2008 2009 2010 2011 2012 2016 strategy, vision, } define targets integrated safety culture measurement actions for improvement measurement actions for improvement patient safety event management Preparation installation of notification system use of notification system in all Belgian hospitals notification system In preparation of project analysis retrospective retrospective + proactive improvement define intramural processes extramural processes development new standardized, integrated, indicators pilot (only acute hospitals) cartography indicators multidimensional set
  • 8. Response of the field 97 98 90 91 91 100 90 80 80 70 60 2007-2008 50 2008-2009 40 2009-2010 30 20 10 0 % hospitals % beds
  • 10. Why taxonomy? • Prime target: aggregation of data • Study and analysis of data-collections: • Detection of patterns and trends • Sharing, structuring and communicating available knowledge • Quality surveillance • Different levels: • Hospital • Between hospitals: Regional network National International • Specialisms (Netherlands: Neosafe, Prima-RT)
  • 11. Conditions for success • Clear, understandable and reproducible • Good balance between: • Sufficient detail – specificity • Ease of use: limited training must suffice ( ICD9) • On implementation: • Minimal negative impact on existing systems • Comparative benefits  buy-in • Efficient • User-friendly • Broad application: Acute hospital, psychiatric institution, rehabilitation center… In-hospital as well as ambulatory care
  • 13. Taxonomy WHO • ICPS International Classification for Patient Safety
  • 14. ICPS: a conceptual framework • 10 high level classes • 48 key concepts • ± 700 concepts
  • 15. ICPS head classes Incident type Incident characteristics Outcome patient Outcome organization Patient characteristics Detection Contributing factors Mitigating factors Ameliorating actions Actions taken to reduce risk
  • 16. Terrifying at first glance…
  • 17. ICPS head classes Incident type Incident characteristics Minimal dataset Outcome patient Outcome organization Patient characteristics Detection Contributing factors Optional Mitigating factors Ameliorating actions Actions taken to reduce risk
  • 18. Application of taxonomy • The person reporting an event • The patient-safety coordinator • The patient-safety team • The person reporting an event has no benefit in taxonomy • Even with a minimal dataset, there is always ballast for someone somewhere • Tailoring the notification system to the local needs is crucial
  • 21. Fitting the taxonomy to the Belgian situation • Translation: Dutch, French, German • Defining a code: • E: Wrong patient D: Verkeerde patiënt F: Patient erroné G: Falscher Patient • Unique hierarchical code
  • 24. Fitting the taxonomy to the Belgian situation • Federal Government provides a uniform XML- model for data-export
  • 25. Reporter Team PatSaf Team PatSaf Repository • Input incident (± • Supplementary • Complete • Reporting taxonomy) info? taxonomy • (Export) • Nominative or • Analysis if (at least minimal anonymous needed data set) • Anonimisation Decentral point of expertise xml • Analysis if needed Committee PatSaf
  • 26. Problems to solve • Clarification of some topics: • i.e. ambulatory versus in-hospital care • Consistency with and linking to existing classifications: • Some are obvious: ICD, ATC, ICF… • But others are not and there is not always consistency between countries • WHO
  • 27. Problems to solve • Parallel registrations: • Mandatory: • Transfusion-incidents • Tissue donation (bone, tympano-ossicular, skin, veins, …) • Infections • … • Others: • Psychiatry • Fall incidents • Radiotherapy • Solitary initiatives… • Avoid duplication • Integration
  • 28. Problems • Legal protection for notification systems • Patient safety act (Denmark) • Netherlands • … • Safety culture: • Health-workers • Organizations • Patient • Society are they all ready for open communication and management?
  • 29. Belgian patient safety project • ICPS is not officially released by the WHO yet • Whish for integration as a standard in Belgian hospitals • WHO: • Request for a use-case in the Belgian hospital- setting  Applying the minimal dataset to patient-safety events  Coding  XML-export  Aggregation of data