TY - JOUR
T1 - The orthopaedic error index
T2 - Development and application of a novel national indicator for assessing the relative safety of hospital care using a cross-sectional approach
AU - Panesar, Sukhmeet S.
AU - Netuveli, Gopalakrishnan
AU - Carson-Stevens, Andrew
AU - Javad, Sundas
AU - Patel, Bhavesh
AU - Parry, Gareth
AU - Donaldson, Liam J.
AU - Sheikh, Aziz
PY - 2013
Y1 - 2013
N2 - Objective: The Orthopaedic Error Index for hospitals aims to provide the first national assessment of the relative safety of provision of orthopaedic surgery. Design: Cross-sectional study (retrospective analysis of records in a database). Setting: The National Reporting and Learning System is the largest national repository of patient-safety incidents in the world with over eight million error reports. It offers a unique opportunity to develop novel approaches to enhancing patient safety, including investigating the relative safety of different healthcare providers and specialties. Participants: We extracted all orthopaedic error reports from the system over 1 year (2009-2010). Outcome measures: The Orthopaedic Error Index was calculated as a sum of the error propensity and severity. All relevant hospitals offering orthopaedic surgery in England were then ranked by this metric to identify possible outliers that warrant further attention. Results: 155 hospitals reported 48 971 orthopaedic-related patient-safety incidents. The mean Orthopaedic Error Index was 7.09/year (SD 2.72); five hospitals were identified as outliers. Three of these units were specialist tertiary hospitals carrying out complex surgery; the remaining two outlier hospitals had unusually high Orthopaedic Error Indexes: mean 14.46 (SD 0.29) and 15.29 (SD 0.51), respectively. Conclusions: The Orthopaedic Error Index has enabled identification of hospitals that may be putting patients at disproportionate risk of orthopaedic-related iatrogenic harm and which therefore warrant further investigation. It provides the prototype of a summary index of harm to enable surveillance of unsafe care over time across institutions. Further validation and scrutiny of the method will be required to assess its potential to be extended to other hospital specialties in the UK and also internationally to other health systems that have comparable national databases of patient-safety incidents.
AB - Objective: The Orthopaedic Error Index for hospitals aims to provide the first national assessment of the relative safety of provision of orthopaedic surgery. Design: Cross-sectional study (retrospective analysis of records in a database). Setting: The National Reporting and Learning System is the largest national repository of patient-safety incidents in the world with over eight million error reports. It offers a unique opportunity to develop novel approaches to enhancing patient safety, including investigating the relative safety of different healthcare providers and specialties. Participants: We extracted all orthopaedic error reports from the system over 1 year (2009-2010). Outcome measures: The Orthopaedic Error Index was calculated as a sum of the error propensity and severity. All relevant hospitals offering orthopaedic surgery in England were then ranked by this metric to identify possible outliers that warrant further attention. Results: 155 hospitals reported 48 971 orthopaedic-related patient-safety incidents. The mean Orthopaedic Error Index was 7.09/year (SD 2.72); five hospitals were identified as outliers. Three of these units were specialist tertiary hospitals carrying out complex surgery; the remaining two outlier hospitals had unusually high Orthopaedic Error Indexes: mean 14.46 (SD 0.29) and 15.29 (SD 0.51), respectively. Conclusions: The Orthopaedic Error Index has enabled identification of hospitals that may be putting patients at disproportionate risk of orthopaedic-related iatrogenic harm and which therefore warrant further investigation. It provides the prototype of a summary index of harm to enable surveillance of unsafe care over time across institutions. Further validation and scrutiny of the method will be required to assess its potential to be extended to other hospital specialties in the UK and also internationally to other health systems that have comparable national databases of patient-safety incidents.
UR - http://www.scopus.com/inward/record.url?scp=84889833987&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2013-003448
DO - 10.1136/bmjopen-2013-003448
M3 - Article
C2 - 24270831
AN - SCOPUS:84889833987
SN - 2044-6055
VL - 3
SP - 1
EP - 6
JO - BMJ Open
JF - BMJ Open
IS - 11
M1 - e003448
ER -