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Organisation
The work presented was developed in interplay between the ESQH-office for Quality Indicators in Aarhus and the members of the established expert group of WP4. Participating expert group members and external experts assigned by an expert group member in the work concerning the PSIs were:
* MD, PhD. A. Bourek, University Center for Healthcare Quality, Masaryk University, Czech Republic
* Dr. I. Callanan, Vice President of the Irish Society for Quality and Safety in Healthcare
* Dr. K. Essinger, President, HOPE Subcommittee on Co-ordination (Appointed by HOPE) in cooperation with Dr. J. Ahlberg, Medical director, LÖF, Patientforsakring, Sweden
* R. Gijsen, MSc., Health care researcher, epidemiologist in cooperation with J. de Koning, MPH, PhD, Senior health care researcher, project leader (Appointed by CBO, Holland)
* Dr. M. Kallewaard of the Association of Medical Specialists (Appointed by CBO)
* Dr. B. Lilja, Director of the Danish Society for Patient Safety, Denmark in cooperation with Dr. J. Anhoej, the Danish Society for Patient Safety
* Dr. G. Maguerez (Appointed by HAS, France), Dr. med C. Thomeczek, Senior Researcher, Managing Director, the German Agency for Quality in Medicine (AQuMed / AEZQ) Joint Institution of The German Medical Association and the National Association of the Statutory Health Insurance Physicians representing Prof. Dr. med. G. Ollenschläger of the Expert Group
Prof. Jan Mainz, medical director of the Danish Institute for Quality and Accreditation in Healthcare and Dr. Paul Bartels, medical director of the Danish Indicator Project from the ESQH-office in Aarhus participated in the expert group. Project management and scientific work was executed by Solvejg Kristensen, Master of Health Science.
The Stepwise Assessment Indicator Framework Approach
The developed Stepwise Assessment Indicator Framework Approach to select, characterise, and evaluate appropriate indicators is illustrated below. If the indicator does not fulfil all the required demands of a step, it is deleted and not taken any further. The steps are described below.
Step 1. Selecting the indicator
Making sure the indicator addresses relevant and significant patient safety issues: it qualifies as an indicator according to the definition in Table 1, and it can be placed within the bold frame in Table 2.
Table 1. Definition of a Patient Safety Indicator
If the indicator does not fulfil the required demands of step 1, it is deleted.
Table 2 pdf-file here
Step 2. Characterising the indicator
To characterise the indicators Scheme for Characterisation of Indicators is used. It is vital for this step that both the numerator and the denominator are defined.
Step 3. Evaluating the indicator - a brief rating assessment instrument for external application
Indicators were evaluated by each individual member of the expert group using the scoring sheet integrated in the Brief Assessment Instrument.
Table 4 pdf-file here
If the indicator does not fulfil the required demands of step 3 it is deleted. Only indicators meeting all demands in the “Stepwise Assessment Framework Approach” have been fully characterised, evaluated, and recommended.
Step 4. Recommendations for use of the indicator in Europe
Registering and analysing the PSIs has to be feasible. It is crucial, therefore, to aim for a limited set of PSIs that when possible can draw upon existing registries or databases within hospitals and be used for benchmarking. It would be an illusion to think that all aspect of patient safety could be adequately captured in such a set of PSIs.
As the expert group was not able to make definite statements about exact data availability and quality for all the PSIs in all European countries it strived to take cross-cultural registration practices into account in making recommendations for PSI application. The PSIs are divided into four sets dependent on whether the expert group found them:
1. Immediately workable throughout the European health care systems
2. Immediately workable in parts of the European health care systems
3. At present not workable for implementation in Europe – Recommendation for future decision on implementation or
4. Not suitable as a PSI for recommendation in Europe
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