Value, 2010

Imperial College London

October 2010

Researchers at Imperial College London's Faculty of Medicine applied AHRQ Patient Safety Indicators (PSIs) to English hospital admissions data to determine whether the evidence-based indicators used by U.S. hospitals could also assist British National Health Service efforts to reduce patient harm.

Alex Bottle, PhD, an Imperial College Department of Primary Care and Public Health researcher, along with fellow researcher, Paul Aylin, Bachelor of Medicine and Bachelor of Surgery, successfully translated the PSIs into England's systems using look-up files and clinical coding advice. They developed a monitoring tool that included the translated AHRQ PSIs. The PSIs were used because they are evidence-based and increasingly used in the United States and because British counterparts were not available.

The researchers ultimately used nine AHRQ PSIs for validation purposes. The monitoring tool Bottle and Aylin developed allows users to compare their risk-adjusted outcomes with the national average and peers. It is also used by some hospitals to audit flagged PSI records for quality improvement purposes. These indicators are of value "in directing clinical audit towards important areas of potential patient harm, and helping [hospital] trusts assess performance over time," Bottle and Aylin report.

Application of the nine AHRQ PSIs to routine hospital admissions data for the 2005/6 fiscal year revealed a total of 35,918 potential adverse events in English hospitals. Potential adverse events were typically associated with higher mortality, unplanned readmission rates, and longer lengths of stay.

The PSI reports were sent to all National Health Service hospital trusts (a trust can comprise several hospitals) in England. An independent health care information company—Dr. Foster Intelligence, a public-private partnership that aims to improve health care quality through information—distributed the reports. Dr. Foster Intelligence tools provided support for Bottle, Aylin, and colleagues to develop the monitoring tool.

Bottle says, "We know anecdotally that the PSIs are being used in hospitals with access to Dr. Foster Intelligence information tools—around 70 percent of acute hospitals in England."

The hospital trusts each received a 1-year report with their raw and adjusted rates for each PSI compared with national figures. They were invited to respond with their level of interest in the indicators and their own rates. "Twenty-one percent of hospital trusts responded to being sent their figures, and most were positive about using these PSIs in principle," according to the researchers.

The PSIs that were translated and used include the following:

• Decubitus ulcer.
• Postoperative hip fracture.
• Sepsis.
• Death in low mortality diagnosis related groups.
• Foreign body left during procedure.
• Selected infections due to medical care.
• Obstetric trauma: third- and fourth-degree lacerations—vaginal with instrument.
• Obstetric trauma: third- and fourth-degree lacerations—vaginal without instrument.
• Obstetric trauma: third- and fourth-degree lacerations—Caesarian delivery.

Impact Case Study Identifier: CDOM-10-02
AHRQ Product: Patient Safety Indicators
Topic(s): Quality, Cost, Patient Safety
Scope: England

Bottle A, Aylin P. Application of AHRQ patient safety indicators to English hospital data. Qual Saf Health Care 2009;18(4):303-8.

Bottle A, Aylin P. How NHS trusts could use patient safety indicators to improve care. Health Care Risk Rep 2008;14(6):12-14.

Bottle A, Aylin P. Intelligent information: a national system for monitoring clinical performance. Health Serv Res 2008;43(1 Pt 1):10-31.

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