Prevenção de falhas críticas. Os dados coletados rotineiramente podem ser reutilizados para prever danos evitáveis aos pacientes? Um estudo descritivo quantitativo
OBJETIVOS: Determinar se o compartilhamento de dados coletados rotineiramente sobre o desempenho dos serviços de saúde poderia ter previsto falhas críticas de segurança em um serviço de maternidade australiano. DESENHO: Estudo observacional quantitativo descritivo. AMBIENTE: O serviço de maternidade de um hospital público em Victoria, na Austrália. FONTES DE DADOS: Um serviço público de saúde; the Victorian state health quality and safety office-Safer Care Victoria; the Health Complaints Commission; Victorian Managed Insurance Authority; Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Paediatric Infant Perinatal Emergency Retrieval; Australian Health Practitioner Regulation Agency. DESFECHOS PRINCIPAIS: Número e taxas de eventos (atividade, mortes, queixas, processos judiciais, notificações de profissionais clínicos). Coeficientes de correlação. RESULTADOS: Entre 2000 e 2014, o número anual de nascimentos no hospital índice mais que dobrou, sem mudanças no número de leitos, alcançando uma demanda significativamente maior que a de serviços semelhantes, como determinado por um teste t de amostras independentes (p<0,001). Ocorreram 36 mortes de recém-nascidos, das quais 11 foram consideradas evitáveis. As correlações de Pearson revelaram uma relação fraca, mas significativa, entre o número de nascimentos por leito e a mortalidade perinatal (R2=0,18, p=0,003). Testes t de amostras independentes demonstraram que as taxas de transferência neonatal e perinatal de emergência foram ambas significativamente menores que as de serviços semelhantes (ambas com p<0,001). As queixas de pacientes diretamente ao serviço aumentaram antes do reconhecimento do excesso de mortalidade perinatal. CONCLUSÃO: Embora os dados sobre a atividade clínica e as queixas de pacientes diretamente aos serviços pareçam promissores como possíveis preditores de sobrecarga nos serviços de saúde, as queixas às autoridades reguladoras e a atividade médico-legal são menos promissoras como preditores de falhas no sistema. Seriam necessárias mudanças significativas na forma como todos os dados são tratados para progredir com esta abordagem de previsão de falhas nos serviços de saúde.
OBJECTIVES: To determine whether sharing of routinely collected health service performance data could have predicted a critical safety failure at an Australian maternity service. DESIGN: Observational quantitative descriptive study. SETTING: A public hospital maternity service in Victoria, Australia. DATA SOURCES: A public health service; the Victorian state health quality and safety office-Safer Care Victoria; the Health Complaints Commission; Victorian Managed Insurance Authority; Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Paediatric Infant Perinatal Emergency Retrieval; Australian Health Practitioner Regulation Agency. MAIN OUTCOME MEASURES: Numbers and rates for events (activity, deaths, complaints, litigation, practitioner notifications). Correlation coefficients. RESULTS: Between 2000 and 2014 annual birth numbers at the index hospital more than doubled with no change in bed capacity, to be significantly busier than similar services as determined using an independent samples t-test (p<0.001). There were 36 newborn deaths, 11 of which were considered avoidable. Pearson correlations revealed a weak but significant relationship between number of births per birth suite room birth and perinatal mortality (r(2) =0.18, p=0.003). Independent samples t-tests demonstrated that the rates of emergency neonatal and perinatal transfer were both significantly lower than similar services (both p<0.001). Direct-to-service patient complaints increased ahead of recognised excess perinatal mortality. CONCLUSION: While clinical activity data and direct-to-service patient complaints appear to offer promise as potential predictors of health service stress, complaints to regulators and medicolegal activity are less promising as predictors of system failure. Significant changes to how all data are handled would be required to progress such an approach to predicting health service failure.OBJECTIVES: To determine whether sharing of routinely collected health service performance data could have predicted a critical safety failure at an Australian maternity service. DESIGN: Observational quantitative descriptive study. SETTING: A public hospital maternity service in Victoria, Australia. DATA SOURCES: A public health service; the Victorian state health quality and safety office-Safer Care Victoria; the Health Complaints Commission; Victorian Managed Insurance Authority; Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Paediatric Infant Perinatal Emergency Retrieval; Australian Health Practitioner Regulation Agency. MAIN OUTCOME MEASURES: Numbers and rates for events (activity, deaths, complaints, litigation, practitioner notifications). Correlation coefficients. RESULTS: Between 2000 and 2014 annual birth numbers at the index hospital more than doubled with no change in bed capacity, to be significantly busier than similar services as determined using an independent samples t-test (p<0.001). There were 36 newborn deaths, 11 of which were considered avoidable. Pearson correlations revealed a weak but significant relationship between number of births per birth suite room birth and perinatal mortality (r(2) =0.18, p=0.003). Independent samples t-tests demonstrated that the rates of emergency neonatal and perinatal transfer were both significantly lower than similar services (both p<0.001). Direct-to-service patient complaints increased ahead of recognised excess perinatal mortality. CONCLUSION: While clinical activity data and direct-to-service patient complaints appear to offer promise as potential predictors of health service stress, complaints to regulators and medicolegal activity are less promising as predictors of system failure. Significant changes to how all data are handled would be required to progress such an approach to predicting health service failure.
