الفهرس 
Patient SafetyOnly 14 pages are availabe for public view
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Abstract
Patient safety is a critical component of healthcare quality.
With growing international interest in patient safety, there is
increasing need to monitor the safety of organizations and
evaluate safety initiatives. Measuring the scale and impact of
safety incidents, however is a major challenge, and estimates of
deaths caused by such incidents vary widely.
Agency for Healthcare Research and Quality )AHRQ( developed
the Patient safety indicators (PSIs). The Patient Safety
Indicators (PSIs) were developed as a tool for hospitals to
identify potentially preventable complications and improve
patient safety performance. In previous studies, PSIs have been
associated with increased length of stay (LOS), mortality,
unplanned readmission. The PSIs were developed after a
comprehensive literature review, analysis of available ICD-9-
CM1 codes, review by a clinician panel, implementation of risk
adjustment, and empirical analyses. Very recently, AHRQ took
steps to enhance the utility of this tool by releasing a new
version of the PSI software that uses ICD -10, which contain
18 PSIs.
Research Question: Do patient safety indicators affect the
clinical outcomes including inpatients length of stay, mortality
and 30-day readmission at Cardiothoracic Surgery patients?Objective: To measure the association between Patient Safety
Indicators (PSIs) and clinical outcomes at Cardio-thoracic
Surgery hospital including inpatient length of stay, mortality
from any cause during hospitalization and 30-day unplanned
readmission.
The current study is an exploratory prospective cohort study
conducted to follow up patients from admission till 1 month
after discharge. The target population of the study was all
admitted patients to the Cardio-thoracic Surgery Hospital. The
sample was all patients admitted who fulfill the inclusion criteria
during the 3 months of the study.
Main findings showed that males constituted about (59%) of the
330 included patients and mean age was (48.78±14.63). Most of
the patients were married (77%) and live in urban areas (54%).
The studied participants were mainly admitted from outpatient
clinic (elective cases) (75%) and most of them (94%) were
admitted to internal department. The most common performed
surgery was cardiac surgeries (75%). At the time of discharge,
(92%) of the studied sample were at improvement status and
(5%) died. Fifty four percent of the studied cases stayed in the
hospital more than 10 days and the unplanned readmitted cases
within 30 days accounted for (6%).
The incidence rate of PSI3 (pressure ulcer rate) was 67.7 per
1000 discharges at risk. The risk of development PSI3 in patients more than 60 years old is 8.6 times in cases less than 36
years old (p= 0.071). The risk of death in cases developed PSI3
is 8.7 times the risk of death in cases without PSI3 (p=0.00). The
risk of unplanned readmission within 30 days in cases with PSI3
is 2.3 times the risk of readmission in cases without PSI3 (p=
0.553). The risk of staying more than 10 days at the hospital in
patients developed PSI3 is 1.5 times the risk in patients without
PSI3 (p= 0.008).
The incidence rate of PSI9 (perioperative hemorrhage or
hematoma) was 49.54 per 1000 discharges at risk. The risk of
development PSI9 in patients admitted directly to ICU is 5.6
times in patients admitted to internal department (p=0.008). The
risk of death in cases developed PSI9 is 2.4 times the risk of
death in cases without PSI9 (p=0.215). The risk of unplanned
readmission within 30 days in cases with PSI9 is 2.4 times the
risk of readmission in cases without PSI3 (p= 0.283). The risk of
staying more than 10 days at the hospital in patients developed
PSI9 is 1.26 times the risk to stay more than 10 days in patients
without PSI9 (p= 0.26).
The incidence rate of PSI13 (postoperative sepsis) was 40.6 per
1000 discharges at risk. The risk of death in cases developed
PSI13 is 4.74 times the risk of death in cases without PSI13
(p=0.005). The risk of readmission within 30 days in cases
developed PSI13 is 3.4 times the risk of readmission in cases
without PSI13 (p=0.163). The incidence rate of PSI10 (postoperative acute kidney injury
required dialysis) was 12.54 per 1000 discharges at risk. All
cases developed PSI10 were dead. The incidence rate of PSI12
(perioperative pulmonary embolism or DVT) was 6.21 per 1000
discharges at risk. The association between the occurrence of
PSI12 and the studied clinical outcomes was statistically
insignificant. There was no death or readmission reported in
cases developed PSI12.
The current study reported only one case with PSI16
(transfusion reaction). There were no cases reported with PSI5
(retained surgical items) or PSI7 (CVC blood stream infection).
from the current study, it is concluded that the PSI3 (pressure
ulcer rate) was the highest incidence rate, then PSI9
(perioperative hemorrhage or hematoma), then PSI13
(postoperative sepsis). Almost all PSIs associated with death,
readmission within 30 days and increased length of stay. The
association between mortality and occurrence of patient safety
indicators is statistically significance especially PSI3, PSI10 and
PSI13. The association between staying 10 days in the hospitals
and the occurrence of patient safety indicators is statistically
significance especially PSI3, PSI13.
The recommendations include continuous assessment of patients
to early detect PSI cases to prevent further complications.
Training sessions for physicians and nurses about the importance of patient safety measures such as patient safety indicators.
Giving the attention to the full documentation in the medical
records for the complications and PSI measurements.