Validating the International Classification for Patient Safety (ICPS): The Belgian Experience. Looy L. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Luc Van Looy
Medical Director
GZA Hospitals
Antwerpen, Belgium

2. THE PATIENT SAFETY PLAN
OF THE BELGIAN FEDERAL
GOVERNMENT

3. Patient safety
• Quality of care:
• Patient-centered
• Accessible
• Accurate
• In time
• Effective
• Efficient
• Affordable
• Safe

4. Patient safety
• Damage can have many faces and can hit all of
us
• Reports IOM:
• 1999 „To err is human‟
• 2001 „Crossing the quality chasm‟
• Targeting the system, not the individual
• “Events” (adverse events, near misses)
• Safety culture

5. Patient safety in Belgium
Federal Government project
• 5 year project
2007-2012
• Funding:
• National budget 7.216.214 € / year
• 104 € / hospital bed
• Hospitals with <100 beds: 10.000 €.
• Free participation, but with engagement

6. Engagement from the hopitals
• Installing:
• A central steering patient-safety-committee
• An operational patient-safety-team
• Implementation of a safety-management-system:
• Event notification
• Analysis
• Improvement actions
• Follow-up (indicators)
• Paving the way for future aggregation:
• Uniformity of data
• Classification  taxonomy

7. 5 year plan
2013-
2007 2008 2009 2010 2011 2012 2016
strategy, vision,
}
define
targets
integrated
safety culture measurement actions for improvement measurement actions for improvement patient safety
event management
Preparation installation of notification system use of notification system in all Belgian hospitals
notification system In preparation
of project
analysis retrospective retrospective + proactive
improvement define intramural processes extramural processes
development new standardized, integrated,
indicators pilot (only acute hospitals) cartography
indicators multidimensional set

8. Response of the field
97 98
90 91 91
100
90 80
80
70
60 2007-2008
50 2008-2009
40 2009-2010
30
20
10
0
% hospitals % beds

9. FOCUS ON TAXONOMY

10. Why taxonomy?
• Prime target: aggregation of data
• Study and analysis of data-collections:
• Detection of patterns and trends
• Sharing, structuring and communicating available knowledge
• Quality surveillance
• Different levels:
• Hospital
• Between hospitals:
Regional network
National
International
• Specialisms (Netherlands: Neosafe, Prima-RT)

11. Conditions for success
• Clear, understandable and reproducible
• Good balance between:
• Sufficient detail – specificity
• Ease of use: limited training must suffice ( ICD9)
• On implementation:
• Minimal negative impact on existing systems
• Comparative benefits  buy-in
• Efficient
• User-friendly
• Broad application:
Acute hospital, psychiatric institution, rehabilitation
center…
In-hospital as well as ambulatory care

12. Taxonomy JCAHO

13. Taxonomy WHO
• ICPS
International
Classification
for Patient Safety

14. ICPS: a conceptual framework
• 10 high level
classes
• 48 key concepts
• ± 700 concepts

15. ICPS head classes
Incident type
Incident characteristics
Outcome patient
Outcome organization
Patient characteristics
Detection
Contributing factors
Mitigating factors
Ameliorating actions
Actions taken to reduce risk

16. Terrifying at first glance…

17. ICPS head classes
Incident type
Incident characteristics
Minimal dataset
Outcome patient
Outcome organization
Patient characteristics
Detection
Contributing factors Optional
Mitigating factors
Ameliorating actions
Actions taken to reduce risk

18. Application of taxonomy
• The person reporting an event
• The patient-safety coordinator
• The patient-safety team
• The person reporting an event has no benefit in
taxonomy
• Even with a minimal dataset, there is always
ballast for someone somewhere
• Tailoring the notification system to the local
needs is crucial

19. Tailoring the notification system

20. Incorporation in event-notification

21. Fitting the taxonomy to the Belgian
situation
• Translation: Dutch, French, German
• Defining a code:
• E: Wrong patient
D: Verkeerde patiënt
F: Patient erroné
G: Falscher Patient
• Unique hierarchical code

22. Translations and codes

23. Basis for aggregation

24. Fitting the taxonomy to the Belgian
situation
• Federal Government provides a uniform XML-
model for data-export

25. Reporter Team PatSaf Team PatSaf Repository
• Input incident (± • Supplementary • Complete • Reporting
taxonomy) info? taxonomy • (Export)
• Nominative or • Analysis if (at least minimal
anonymous needed data set)
• Anonimisation
Decentral point of expertise xml
• Analysis if needed
Committee PatSaf

26. Problems to solve
• Clarification of some topics:
• i.e. ambulatory versus in-hospital care
• Consistency with and linking to existing
classifications:
• Some are obvious: ICD, ATC, ICF…
• But others are not and there is not always
consistency between countries
• WHO

27. Problems to solve
• Parallel registrations:
• Mandatory:
• Transfusion-incidents
• Tissue donation (bone, tympano-ossicular, skin, veins, …)
• Infections
• …
• Others:
• Psychiatry
• Fall incidents
• Radiotherapy
• Solitary initiatives…
• Avoid duplication
• Integration

28. Problems
• Legal protection for notification systems
• Patient safety act (Denmark)
• Netherlands
• …
• Safety culture:
• Health-workers
• Organizations
• Patient
• Society
are they all ready for open communication and
management?

29. Belgian patient safety project
• ICPS is not officially released by the WHO yet
• Whish for integration as a standard in Belgian
hospitals
• WHO:
• Request for a use-case in the Belgian hospital-
setting
 Applying the minimal dataset to patient-safety
events
 Coding
 XML-export
 Aggregation of data