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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
   •   Effecti...
Patient safety

• Damage can have many faces and can hit all of
  us
• Reports IOM:
  • 1999 „To err is human‟
  • 2001 „C...
Patient safety in Belgium
Federal Government project
• 5 year project
  2007-2012
• Funding:
   • National budget 7.216.21...
Engagement from the hopitals

• Installing:
   • A central steering patient-safety-committee
   • An operational patient-s...
5 year plan



                                                                                                           ...
Response of the field

                                   97   98
             90      91   91
100

 90   80

 80

 70

 6...
FOCUS ON TAXONOMY
Why taxonomy?

• Prime target: aggregation of data
  • Study and analysis of data-collections:
     • Detection of pattern...
Conditions for success

• Clear, understandable and reproducible
• Good balance between:
  • Sufficient detail – specifici...
Taxonomy JCAHO
Taxonomy WHO

• ICPS

 International
 Classification
 for Patient Safety
ICPS: a conceptual framework

                   • 10 high level
                     classes
                   • 48 key ...
ICPS head classes

    Incident type
    Incident characteristics

    Outcome patient
    Outcome organization

    Patie...
Terrifying at first glance…
ICPS head classes

    Incident type
    Incident characteristics
                                   Minimal dataset
    O...
Application of taxonomy

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

• The...
Tailoring the notification system
Incorporation in event-notification
Fitting the taxonomy to the Belgian
situation
• Translation: Dutch, French, German
• Defining a code:
  • E:     Wrong pat...
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   • Compl...
Problems to solve

• Clarification of some topics:
   • i.e. ambulatory versus in-hospital care
• Consistency with and lin...
Problems to solve

• Parallel registrations:
   • Mandatory:
       •   Transfusion-incidents
       •   Tissue donation (...
Problems

• Legal protection for notification systems
  • Patient safety act (Denmark)
  • Netherlands
  • …
• Safety cult...
Belgian patient safety project

• ICPS is not officially released by the WHO yet
• Whish for integration as a standard in ...
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Validating the International Classification for Patient Safety (ICPS): The Belgian Experience

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Validating the International Classification for Patient Safety (ICPS): The Belgian Experience. Looy L. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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

  1. 1. Luc Van Looy Medical Director GZA Hospitals Antwerpen, Belgium
  2. 2. THE PATIENT SAFETY PLAN OF THE BELGIAN FEDERAL GOVERNMENT
  3. 3. Patient safety • Quality of care: • Patient-centered • Accessible • Accurate • In time • Effective • Efficient • Affordable • Safe
  4. 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. 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. 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. 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. 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
  9. 9. FOCUS ON TAXONOMY
  10. 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. 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
  12. 12. Taxonomy JCAHO
  13. 13. Taxonomy WHO • ICPS International Classification for Patient Safety
  14. 14. ICPS: a conceptual framework • 10 high level classes • 48 key concepts • ± 700 concepts
  15. 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. 16. Terrifying at first glance…
  17. 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. 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
  19. 19. Tailoring the notification system
  20. 20. Incorporation in event-notification
  21. 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
  22. 22. Translations and codes
  23. 23. Basis for aggregation
  24. 24. Fitting the taxonomy to the Belgian situation • Federal Government provides a uniform XML- model for data-export
  25. 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. 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. 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. 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. 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
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