Table 17 'Foreign Body left during Procedure'

PSI 16: Foreign Body left during Procedure
Origin: Review of a common OECD/AHRQ/CIHI PSI (3;33)
Dimension Description
Description of Specific
Aspects of Patient Safety
Although surgeons and operating room teams rely on the practice of
counts of sponges, sharp and instrument as a means to eliminate
detained foreign bodies, practices are not standardised and every single
events may signal a serious system failure that should be addressed.
Thus foreign body left during procedure is a suitable measure of
patient safety.
Aim of the PSI This PSI is intended to flag cases of a foreign body accidentally left in
a patient during a procedure.
Level of Determination of
Patient Safety
Safety can be assessed at the individual and the aggregated patient
level. Though due to the rarity of foreign body left during procedure
and the severity of the event, safety is recommended assessed at the
individual patient level.
Source(s) This indicator was originally proposed by Iezzoni et al. as part of the
Complications Screening Program (CSP “sentinel events”). It was also
included as one component of a broader indicator (“adverse events and
iatrogenic complications”) in AHRQs original HCUP Quality
Indicators.
It was proposed by Miller et al. in the “Patient Safety
Indicator Algorithms and Groupings.”
The PSI is defined on both a provider level (by restricting cases to
those included both medical and surgical patients, but flagged by a
secondary diagnosis or procedure code) and an area level (by including
all cases).
Organisations responding to the same theme are Australian Incident
Monitoring System and National Patient Safety Agency in the UK
(3;33).
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 lead to a recommendation of 86 indicators of
which 21 covers aspects of patient safety (34).
The project team developing the AHRQ PSI conducted extensive
empirical analyses on this PSI. The team concluded that this PSI
generally performs well on several different dimensions, including
reliability, bias, relatedness of indicators, and persistence over time (3).
The AHRQ PSI software was applied to Veteran Affairs (VA)
administrative data to identify potential instances of compromised
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patient safety; determine occurrence rates of PSI events in the VA;
and examine the construct validity of the PSIs. The study population
was 97% male, with a mean age of 65 years, 54% were age 65 and
older. All together 11411 PSI events were identified, 46% of PSI
events occurred in surgical hospitalisation and 54% in medical
hospitalisation. The observed PSI rate per 1000 discharges was 0.17
for foreign body left during procedure. This PSI was significantly
associated with the AHRQ PSIs for selected infections due to medical
care and technical difficulty with procedure. Statistical significantly
differences were found for hospitalisations with PSI events and those
without PSI events for longer lengths of stay and higher costs (4).
The performance of the AHRQ PSIs was analysed to: 1) provide a
descriptive analysis of the incidence of PSI events from 2001 to 2004
in the VA; 2) examine trends in national PSI rates at the hospital
discharge level over time; and 3) assess whether hospital
characteristics (teaching status, number of beds, and degree of quality
improvement implementation) and baseline safety-related hospital
performance predict future hospital safety-related performance. Riskadjusted
rates of the PSI for iatrogenic pneumothorax and failure to
rescue demonstrated a consistent rate over time. Future research should
investigate whether trends reflect better or worse care or increased
attention to documenting patient safety events (5).
Administrative data from community hospitals in 16 US states with
reliable race/ethnicity measures using the AHRQ PSIs was analysed to
determine whether racial and ethnic differences in patient safety
events disappear when income (a proxy for socioeconomic status) is
taken into account. No differences in the occurrence of this PSI event
were found according to race. It was concluded that: ”The AHRQ
PSIs are a broad screen for potential safety events that point to needed
improvement in the quality of care for specific populations” (7).
The results suggest that this PSI may be useful as a measure of patient
safety (3-5;7;8;33;34).
AHRQ is determining the feasibility and practicality in a project
concerning validation of selected AHRQ Quality Indicators (8).
Evidence of Clinically use
of Standards
No evidence of clinically use of standards was found.
PSI category Theme Related PSI: “Surgical Complication”.
Data definitions Discharges with foreign body accidentally left in during procedure per
1000 discharges.
Numerator Description Discharges with ICD-9-CM codes for foreign body left in during
procedure in any secondary diagnosis field.
Denominator Description All medical and surgical discharges, 18 years and older or MDC 14
(pregnancy, childbirth, and puerperium), defined by specific DRGs.
Exclude cases with ICD-9-CM codes for foreign body left in during
procedure in the principal diagnosis field.
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Data Source Administrative data.
Identifying the
institutional context
Complications due to foreign bodies left during procedure make this
PSI important for both financial and quality improvement policies.
Care Setting The PSI applies for high quality surgical care.
Professionals Responsible
for Health Care
Surgeons.
Lowest Level of Health
Care Delivery Addressed
Individual clinical units or departments.
Allowance for Patient
Factors
Risk Adjustment for: Age, sex, DRG, comorbidity categories when
restricting cases to those included both medical and surgical patients,
but flagged by a secondary diagnosis or procedure code.
No risk adjustment when including all cases.
Stratification by
Vulnerable Populations
No stratification.
Standard of Comparison No specific standards given.
Scoring AHRQ has PSI software for scoring.