Facilitating Cross-National Comparisons of Indicators for Patient ...

DELSA/ELSA/WD/HTP(2008)15. The conference concluded with a commitment to increase the potential of cross nationalcomparisons of patient safety through two key work initiatives focussing on:• Adaptation of hospital administrative data systems for facilitating cross-national comparativeinformation of Patient Safety Indicators (PSI), and• Reviewing adverse event reporting systems.6. As part of the overall effort under the first of these initiatives, this manual seeks to facilitate crossnational comparisons of indicators for patient safety through the provision of detailed practical advice oncalculating each indicator selected from a recommended set of Patient Safety Indicators (PSI) 2 utilisingnational hospital administrative databases.7. The set of indicators selected for further analysis and specification is summarised in Table 1.Table 1: Selected Patient Safety IndicatorsAreaHospital-acquired infectionsOperative and post-operativecomplicationsSentinel eventsObstetricsIndicator nameInfection due to medical careDecubitus ulcerComplications of anaesthesiaPostoperative hip fracturePostoperative pulmonary embolism (PE) or deep veinthrombosis (DVT)Postoperative sepsisTechnical difficulty with procedurePostoperative respiratory failureIatrogenic pneumothoraxTransfusion reactionForeign body left in during procedureBirth trauma - injury to neonateObstetric trauma – vaginal delivery with instrumentObstetric trauma – vaginal delivery without instrumentObstetric trauma - caesarean section8. These indicators are a set of indicators providing information on potential in-hospitalcomplications and adverse events following surgeries, procedures, and childbirth. They were developedafter a comprehensive literature review, analysis of ICD-9-CM codes, clinician panel review,implementation of risk adjustment, and empirical analyses.9. Methods to calculate the values of these indicators from hospital administrative data systemshave until now been carried out only on local and national levels. In this manual, several steps are outlinedto validate a methodology that could be applied internationally for data comparability. The first is a data-2 The OECD HCQI Project convened a panel of experts on indicators for patient safety in 2004. Using astructured interview process the panel came forward with a recommendation that 21 indicators be furtherconsidered. See Millar J et al (2004).8