Perioperative patient safety indicators and hospital surgical volumes

BMC Research Notes

Tomonori Hasegawa¹  Hirotoshi Nishizawa³  Shuhei Iida²  Ai Yoshida³  Shigeru Fujita¹  Kunichika Matsumoto¹  Takefumi Kitazawa¹ 

[1] Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-nishi, Ota-ku, Tokyo 143-8540, Japan;Institute for Healthcare Quality Improvement, Tokyo Healthcare Foundation, 1-24-1, Asahigaoka, Nerima-ku, Tokyo 176-8530, Japan;All Japan Hospital Association, Sumitomo Fudosan Sarugaku-cho Building 7F, 2-8-8, Sarugaku-cho, Chiyoda-ku, Tokyo 101-8378, Japan

关键词: Hospital surgical volume;    Observational study;    Perioperative care;    Patient safety indicators;   

Others  :  1134399
DOI  :  10.1186/1756-0500-7-117

 received in 2014-02-08, accepted in 2014-02-26,  发布年份 2014

【 摘 要 】

Background

Since the late 1990s, patient safety has been an important policy issue in developed countries. To evaluate the effectiveness of the activities of patient safety, it is necessary to quantitatively assess the incidence of adverse events by types of failure mode using tangible data. The purpose of this study is to calculate patient safety indicators (PSIs) using the Japanese Diagnosis Procedure Combination/per-diem payment system (DPC/PDPS) reimbursement data and to elucidate the relationship between perioperative PSIs and hospital surgical volume.

Methods

DPC/PDPS data of the Medi-Target project managed by the All Japan Hospital Association were used. An observational study was conducted where PSIs were calculated using an algorithm proposed by the US Agency for Healthcare Research and Quality. We analyzed data of 1,383,872 patients from 188 hospitals who were discharged from January 2008 to December 2010.

Results

Among 20 provider level PSIs, four PSIs (three perioperative PSIs and decubitus ulcer) and mortality rates of postoperative patients were related to surgical volume. Low-volume hospitals (less than 33rd percentiles surgical volume per month) had higher mortality rates (5.7%, 95% confidence interval (CI), 3.9% to 7.4%) than mid- (2.9%, 95% CI, 2.6% to 3.3%) or high-volume hospitals (2.7%, 95% CI, 2.5% to 2.9%). Low-volume hospitals had more deaths among surgical inpatients with serious treatable complications (38.5%, 95% CI, 33.7% to 43.2%) than high-volume hospitals (21.4%, 95% CI, 19.0% to 23.9%). Also Low-volume hospitals had lower proportion of difficult surgeries (54.9%, 95% CI, 50.1% to 59.8%) compared with high-volume hospitals (63.4%, 95% CI, 62.3% to 64.6%). In low-volume hospitals, limited experience may have led to insufficient care for postoperative complications.

Conclusions

We demonstrated that PSIs can be calculated using DPC/PDPS data and perioperative PSIs were related to hospital surgical volume. Further investigations focusing on identifying risk factors for poor PSIs and effective support to these hospitals are needed.

【 授权许可】

   
2014 Kitazawa et al.; licensee BioMed Central Ltd.

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