Table 12 'Wound Infection'

PSI 11: Wound Infection
Origin: Review of a OECD PSI (33)
Dimension Description
Description of Specific
Aspects of Patient Safety
The occurrence of a wound infection can have clinical consequences
ranging from insignificant inflammation to considerable pain and
suffering, wound disruption, septicaemia and death. Due to infection
re-operation and prolonged hospitalisation might required. The
incidence of wound infection can be reduced by proper pre-, intra- and
post-operative care, in particular strict hygiene. Various clinical work
processes are proven to be linked to wound infections. Thus wound
infection is a suitable measure of patient safety.
Aim of the PSI This PSI is intended to flag cases of wound infections.
Level of Determination of
Patient Safety
Safety is assessed at the aggregated patient level.
Source(s) Origin the Complications Screening Programme.
Extent of Clinically
Testing
The OECD Health Care Quality Indicators (HCQI) Project was
initiated to implement quality measures for international benchmarking
of medical care at the health system level. Five priority areas including
patient safety were selected. International expert panels were formed to
identify clinically important, scientifically sound, and feasible
measures based on a structured consensus process. The consensus
process was successfully completed in all five priority areas leading to
a recommendation of 86 indicators of which 21 cover patient safety
(34).
The Complications Screening Program (CSP) aims to identify 28
potentially preventable complications of hospital care using
computerised discharge abstracts, including demographic information,
diagnosis and procedure codes. A study was set up to validate the CSP
as a quality indicator. Explicit process of care criteria were used to
determine whether hospital discharges flagged by the CSP experienced
more process problems than unflagged discharges. The CSP was
applied to computerised hospital discharge abstracts from Medicare
beneficiaries > 65 years old admitted in 1994 to hospitals in California
and Connecticut for major surgery or medical treatment. The final
sample included 740 surgical and 416 medical discharges. Rates of
process problems were high, ranging from 24.4 to 82.5% across CSP
screens for surgical cases. Problems were lower for medical cases,
ranging from 2.0 to 69.1% across CSP screens. Problem rates were
45.7% for surgical and 5.0% for medical controls. Rates of problems
did not differ significantly across flagged and unflagged discharges.
The researchers concluded: “The CSP did not flag discharges with
significantly higher rates of explicit process problems than unflagged
SImPatIE WP4 – Catalogue of Patients Safety Indicators
33
discharges” (37).
Another study of the CSP was undertaken to study the accuracy of
computer algorithms on administrative data to identify hospital
complications. The assessment was based on a medical records
indicator differentiating hospital-acquired conditions from pre-existing
comorbidities. Indicators for identifying potential hospital
complications were applied to all secondary diagnoses for all 1997-
1998 discharges. The researchers concluded: “Current complication
algorithms identify many cases where the condition was actually
present on hospital admission. This fact, coupled with the known
variability in coding between institutions, makes comparisons between
hospitals on many of the complications problematic. Collection of the
present-on-admission flag significantly reduces the noise in monitoring
complication rates (38).
The results suggest that this PSI may be useful as a measure of patient
safety (33;37).
Evidence of Clinically use
of Standards
No evidence of clinically use of standards was found.
PSI category Theme Related PSI: “Infection Control”.
Data definitions Cases of wound infection.
Numerator Description Patients experiencing a wound infection (ICD-9 998.51 and 998.52).
Secondary diagnosis only.
Denominator Description All hospitalised patients.
Data Source Administrative data.
Identifying the
institutional context
The impact of wound infections makes this PSI important for both
financial and quality improvement policies.
Care Setting The PSI applies for high quality nursing care.
Professionals Responsible
for Health Care
Nurses.
Lowest Level of Health
Care Delivery Addressed
Individual clinical department.
Allowance for Patient
Factors
No risk adjustment described.
Stratification by
Vulnerable Populations
No stratification.
Standard of Comparison No specific standards given.
Scoring No specific standards for scoring given.