Hospital Harm Index

Presentation to MAPS Exploratory Work Group for Tracking Safety Progress

April 10, 2013

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November 30, 1999:

The Institute of Medicine

Committee on Quality of Health Care in America

announces its first report:

To Err is Human: Building a Safer Health System

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Care-associated injuries in hospitals

account for

44,000 – 98,000 preventable deaths per year

in the United States

More people die from hospital-based preventable medical injuries than from breast cancer or AIDS or motor vehicle accidents

Brennan et al. New Engl J Med 1991

Thomas et al. 1999

Injuries drive direct health care costs totaling

$9 – 15 billion per yearThomas et al. 1999

Johnson et al. 1992

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Key Findings in IOM report:

• Injuries occur because of system failures

• Preventing injuries means designing safer systems of care

• Organizations, not individual physicians and nurses, control those systems of care

Committee on Quality of Health Care in America. To Err is Human. Institute of Medicine , 2000.

Harm Index• Harm Index was developed to provide a

single value that reflects the priority focus adverse events.

• The measurement shows the variance from expected, displayed as a single composite.

• Expected events are goal values, based on historical performance and targets

• Harm Index = Actual Events – Expected Events

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Priority Focus Adverse Events

• Inpatient Falls With Harm• Clostridium difficile (C-Diff)• Cent. Line Assoc. Blood Stream Infection

(CLABSI)• Catheter Assoc. Urinary Tract Infections

(CAUTI)• Wrong Site Surgery/Procedure• Pressure Ulcers

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Harm Index Calculations – Hospital Level

Allina Health Hospital January 2013 Hospital Level

Falls Goal = 0.76 Harmful Falls / 1,000 Patient Days

0.76

Inpatient Days 15,096Expected Falls Based on Days(0.76 x (15,096 /1,000)) = 11.5

11.5

Actual Harmful Falls Jan 2013 9Lives Positively Affected (Harm Index) 2.5

The following table shows actual January 2013 results, of the harm index calculation for falls for a single Allina Health Hospital.

Harm Index Calculations – Hospital Level

• Clostridium difficile • Reduce CDI run rate from 8.72 per 10,000 patient

days to 7.2 CDI per 10,000 patient days.• Utilizes the same basic calculation as falls• (Actual C. diff Patients - (Goal x (Days / 10,000)))

• Catheter Assoc. Urinary Tract Infection • Reduce CAUTI pooled rate to 3.0 per 1,000

catheter days in specific areas.• (Actual CAUTI Pts – (Goal x (Cath Day / 1,000)))

Harm Index Calculations – Hospital Level• Wrong Site Surgery

• Achieve absolute zero• (Actual Wrong Site Patients – 0 Expected)

• Pressure Ulcer• Reduce reportable pressure ulcers• Number of reportable PU <= 10 annually• (Actual Reportable PU – 10 Expected)

• Central Line Assoc. Blood Stream Infections • Reduce to 25th percentile of national rate• Number of CLABSI <= 4 annually• (Actual CLABSI Patients – 4 Expected)

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Other Patient Safety Indicators

1. Hand Hygiene Compliance

2. # PVSRs Reported (Voluntary Incident

Reporting System)

3. Effective Opioid Management (Clinics)

In Addition:

4. 3 Years of AHRQ Patient Safety Culture Survey (Hospitals)

5. 2 Years of AHRQ Patient Safety Culture Survey (Clinics)