In 2014-15, one in 18 hospital stays in Canada involved at least one harmful event (138,000 out of 2.5 million hospital stays). Of those, 30,000 (or one in five) involved more than one form of harm. While most patients experience safe care, sometimes harmful events happen that affect patients. Many of these events are preventable.
The Canadian Institute of Health Information (CIHI) and the Canadian Patient Safety Institute (CPSI) are working to address a gap in patient safety measurement by collecting data on how often these events are happening and providing information on how these events can be prevented. Through the development a Hospital Harm Improvement Resource and the Measuring Patient Harm in Canadian Hospitals report, system decision-makers, hospital executives, clinicians and policy makers now have access to important information on patient safety in acute care hospitals and how to improve it.
The measure and improvement resource comprise a new, readily available tool hospitals can use to improve the safety of their patients and reduce the occurrence of harm. "With the improvement resource, patient safety teams and clinicians can now spend less time researching what to do, and more time planning and implementing changes that are known to work," says Chris Power, CEO of CPSI.
"One avoidable harmful event is one too many," says Bill Tholl, CEO of HealthcareCAN, a national organization that speaks for Canada's hospitals and works to foster informed and continuous improvement in healthcare. "HealthCareCAN welcomes the release of this report and working with CPSI and CIHI to pursue the common goal of quality and reliability for patients."
This work reflects a new approach in helping Canadian hospitals to measure and improve patient safety. "While most patients experience safe care in Canada, we must continually strive to do better," said the Honourable Jane Philpott, Minister of Health. "High-quality data is an important tool in assisting our improvement efforts, and we thank CIHI and CPSI for working together toward this goal."
Why is a measure of harm important?
Until now, there has been no single measure that provides perspective on patient safety in Canadian hospitals. The measure is designed to help organizations identify patient safety improvement priorities and track progress over time.
Measuring Patient Harm in Canadian Hospitals
The Measuring Patient Harm in Canadian Hospitals report provides a summary of the new approach to measuring hospital harm. It provides a big picture view of hospital harm and the status of patient safety in Canada; the number and types of events; and types of patients and their outcomes.
The report introduces readers to the Improvement Resource and provides guidance on how to use the measure for improvement. It reinforces the importance of using the measurement data in conjunction with other currently available data.
The Hospital Harm measure
The Hospital Harm measure was developed jointly by CIHI and CPSI in consultation with leading patient safety experts. The measure represents a new approach to measuring and monitoring harm that occurs in Canadian hospitals. CIHI and CPSI are committed to working with stakeholders across the country to ensure this measure is a useful tool for monitoring and improving patient safety in acute care facilities.
The measure is defined as the rate of acute care hospitalizations with at least one occurrence of unintended harm during a hospital stay that could have potentially been prevented by implementing known evidence-informed practices.
A key advantage of this measure is that it uses existing data already being submitted to CIHI's Discharge Abstract Database (DAD) — no additional data collection is needed. The DAD captures information on hospital discharges across Canada (excluding Quebec). It is well established, has common standards for data collection and has built-in methods for auditing and assuring data quality.
For harm to be included in the measure, it must meet the following three criteria: it is identified within the same hospital stay; requires treatment or prolongs the patient's hospital stay; and is one of the conditions from the 31 clinical groups in the Hospital Harm measure framework.
The Hospital Harm measure captures unintended occurrences of harm that happen during a hospital stay. The measure is made up of clinical groups that fall under four categories, including: Health Care–/Medication-Associated Conditions; Health Care–Associated Infections; and Patient Accidents; and Procedure-Associated Conditions.
The measure captures a range of harmful events, from "never events" — things that should never happen and are completely preventable (e.g., retained foreign body) — to events where implementing evidence-informed practices should reduce the incidence of harm but may not prevent every occurrence (e.g., aspiration pneumonia). While not all instances of harm captured by this measure can be prevented, implementing evidence-informed practices can help to reduce the rate of harm.
The purpose of measuring quality and safety is to improve patient care and optimize patient outcomes. The measure should be used in conjunction with other sources of information about patient safety, including patient safety reporting and learning systems, chart reviews or audits, Accreditation Canada survey results, patient concerns and clinical quality improvement process measures. Together, this information can inform and optimize improvement initiatives.
Hospital Harm Improvement Resource
The Hospital Harm Improvement Resource links measurement and improvement by providing evidence-informed resources that will support patient safety and improvement efforts. The Improvement Resource will help to open conversations about patient safety and improvement.
For patients and families, like Carole Jukosky, the Improvement Resource provides relevant information to prevent harmful events. Carole's dad Herbert Strasser died unexpectedly in September 2011, after a gruelling six-week hospital odyssey, growing sicker every day. Continuity and follow-through were huge issues that affected his care.
"My dad's case is very complex and in the end he had a multitude of issues," says Carole. "It was very confusing to the medical system, very confusing to him and very confusing to our family."
Carole had to dig deep through every medical file and lab result trying to make sense of it all. She met with all the facilities to review her dad's case, supported by a coroner's investigation into what was termed "a perfect storm" of miscues and false assumptions. Carole's prodding and inquiries have led to several healthcare improvements.
The Hospital Harm Improvement Resource provides information on general patient safety tools and quality improvement resources, how to use the Hospital Harm measure, and references and resources specific to each of the 31 clinical groups.
For more information and to access the Improvement Resource, visit www.patientsafetyinstitute.ca or www.cihi.ca