Patient safety in Romania National Health Quality Management Authority Vasile Cepoi, President January 14, 2020
AGENDA O Patient Safety - concept O International context O Role of ANMCS in increasing patient safety O Problems identified by ANMCS in the quality of medical services and patient safety in Romania O Actions carried out by ANMCS O ANMCS actions ongoing
The safety measurement was compared to the fabula in which five blind people describe an elephant in very varying terms (as a wall, fan, spear, snake or tree), depending on which part of the animal has touched In this analogy, the opinion of an institution on its safety issues inevitably depends on the method used to measure safety, and a comprehensive picture can only be obtained by integrating several methods.
Patient Safety Concept O The Institute of Medicine report of 1999 To Err Is Human drew international attention to the problem of patient harm, which can be prevented in medicine and has led to the creation of the modern concept of patient safety. O The impact of the To Err Is Human report demonstrates the importance of rigorous measurement of the incidence and prevalence of preventable injury (EAAAM).
The magnitude of the problem at international level O The size of the phenomenon - up to 4 out of 10 patients are affected in primary and outpatient care centers O Incidence -134 million adverse events occur every year in hospitals in low and middle income countries, contributing to 2,6 million deaths annually due to unsafe care (The economics of patient safety in primary and ambulatory care – Flying O blind (OECD study) O Medication - Medication Errors cost about $42 billion annually O (The third WHO Global Patient Safety Challenge: Medication Without Harm )
International approach O The risk of patient-related healthcare errors has led many countries to invest in more measures to strengthen healthcare systems and improve patient safety. O The efforts started in 2015 and culminated in the launch of The Global Ministerial series Safety Summit. (The first summit was held in London in 2016, followed by Bonn in 2017, Tokyo in 2018 and Jeddah, Kingdom of Saudi Arabia in 2019 )
International approach O The participants of the meeting in the Kingdom of Saudi Arabia (March 2019) decided on the following lines of action: O Promoting the concept of patient safety O Involving the patient in providing their own care and their safety Implementing and supporting national reporting and learning O systems for patient safety O Promoting medication safety O Safety in use of medical devices O Implement infection prevention control strategies (IPC) and antimicrobial resistance (AMR) for safety the patient Sustainable implementation and extension of effective O national and global patient safety interventions.
International approach Five lines of action for ensuring the quality and safety of health services proposed by IOM-SUA O The accreditation of hospitals and outpatient services O Measuring and improving clinical performance O Ensuring patient safety O Involvement of the patient in the provision of his own care O The fifth dimension is the time of changes. O The continuity of measurement of performance over time of each dimension, from benchmarks to achievable goals, validates continuous improvement. (Quality in Healthcare: A Five-Dimensional View, December 4, 2012 ‐ Brooke Schmidt, November / December 2012, Quality in Healthcare: A Five-Dimensional View, By Daniel L. Cohen, MD, FRCPCH, FAAP)
International approach O Council recommendation of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections 1. Support the establishment and development of national policies and programs on patient safety 2. Inform citizens and patients 3. Support the establishment or strengthening of non-accusing identification and reporting systems on adverse events 4. Promote, at the appropriate level, the education and training of healthcare workers on patient safety 5. To classify and measure patient safety at community level, through mutual cooperation and with the Committee 6. To share knowledge, experience and best practices through mutual cooperation and with the Committee, as well as with relevant European and international bodies 7. Develop and promote research into patient safety 8. Adopt and implement a strategy for the prevention and control of healthcare associated infections
Patient Safety Identified problems B . The hospital infrastructure does not meet the needs of the population : O The need for healthcare is not identified There is no strategy to develop USP to meet needs O O The buildings in which hospitals operate do not meet the conditions for authorization (ISU, Health Authorization, Environmental Authorization) and do not meet the requirements to ensure patient privacy, to protect information about the patient's health, etc. C . Organizational management is focused on limiting expenditure to the level of budgetary provisions, without being interested in clinical results The objectives in the strategic plans are unrealistic and do not respond to the national health O strategy O Management is not concerned about ensuring conditions and the environment conducive to ensuring quality and safe services O Management has no responsibility for ensuring and continuously improving the quality of health services and patient safety O Employees in quality management Structures do not have appropriate training to the specific nature of the work and are not supported in the performance of their duties D. The method of payment for the services O Does not stimulate clinical performance O Managers do not make clinical management O It does not monitor costs on the disease O Tariffs do not reflect the real costs of medical assistance - Amounts collected for admitted cases are often equal to or lower than staff costs
4500 Average cost variation/diagnostic-Chronic B Viral Hepatitis without Delta agent 4000 3500 3000 2500 Cost mediu/diagnostic 2000 1500 mediana 1000 500 0 1 2 3 4 5 6 7 8 9
Average cost variation/diagnostic- unspecified, acute Appendicitis 14000 Cost 12000 mediu/diagn ostic 10000 8000 mediana 6000 4000 2000 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
12000 Average cost variation/diagnostic-Essential hypertension (primary) 10000 8000 6000 Cost mediu/dia gnostic 4000 mediana 2000 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Average cost variation/diagnostic - congestive heart disease 9000 8000 7000 6000 5000 Cost 4000 mediu/diag nostic 3000 mediana 2000 1000 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37
Average rage cost/di /diagnostic gnostic minim maxim 7951 7875.92 7523.76 6807.89 5691.13 5436.25 4065 3563.99 1574.83 867.81 771.71 439.29 377.62 245.6 Apendicita Hepatita virala Hipertensiunea Insuficienta Insuficienta Insuficienta Tumora acuta, cronica B fara esentiala cardiaca cardiaca, ventriculara maligna colonul nespecificata agent Delta (primara) congestiva nespecificata stanga ascendent
Contract with C.A.S.- Total staff expenditure 250000 200000 150000 mediana-Contract cu C.A.S.-Spitalizare continuă Contract cu C.A.S.- 100000 Spitalizare continuă TOTAL Cheltuieli cu personal 50000 mediana-TOTAL Cheltuieli cu personal 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33
Patient Safety Identified problems In its activity, ANMCS found that : A. Medical staff is not trained and responsible about: Taking care according to the hospital’s competence and the O patient’s care needs O Ensuring continuity of healthcare O Integrated case Management O Implementing rules of good practice through protocols and procedures specific to each specialty O Evaluation and certification of medical practice O Preventing and limiting potential harm to patients in healthcare O Collaboration with the organizational pole to maintain the financial balance The share of compliance with these requirements, in the 199 evaluated in cycle II accreditation, is below 70%
Actions carried out by ANMCS O The efforts of ANMCS to achieve its objectives of improving the quality of healthcare and patient safety have resulted in the following actions: O The development of a new edition of hospital accreditation standards in line with international principles and has internationally accredited them through ISQua O Promoting the principle of self-regulation and accountability of the USP on how to implement quality of healthcare and patient safety assurance requirements O Development of an IT tool kit for implementation of standards, post-accreditation evaluation and monitoring of the USP to minimize bureaucratic work on quality management O Training more than 1000 doctors and nurses in clinical risk management within regional conferences and workshops
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