© CGI Group Inc. CONFIDENTIAL

Data for Patient Safety Canadian Association of Paediatric Health Centres Conference

Camille Poulin PT, B.Sc.P.T., CPHIMS-CA, PMP

October 24 and 25, 2016

Halifax, NS, Canada

Topics

Improving patient safety - methods and mechanisms

• Trigger tools

• Patient safety indicators, reporting, and actionable insights

The data behind patient safety

• Problem

• Opportunity

Example use case and demo

New use cases? What’s coming next?

2

3

Methods and Mechanisms

Care is provided

As planned? How do you know?

Detection & Reporting

Voluntary

Reporting

Chart Audit

Interviews

Surveys

Patient or Family

Report

Trigger Tools -

Global

Trigger Tools -

Interventionist

Indicators and

Reporting

Trigger tools

4

• Trigger Tool for Measuring Adverse Drug Events

• IHI Skilled Nursing Facility Trigger Tool for

Measuring Adverse Events

• Trigger Tool for Measuring Adverse Drug Events

in a Mental Health Setting

• Surgical Trigger Tool for Measuring Peri-

operative Adverse Events

• Intensive Care Unit Adverse Event Trigger Tool

• Pediatric Trigger Toolkit: Measuring Adverse

Drug Events in the Children’s Hospital

• Perinatal Trigger Tool

• Trigger Tool for Measuring Adverse Events in the

Neonatal Intensive Care Unit

• Outpatient Adverse Event Trigger Tool

Review of the evidence – key points for trigger tools

• Sampling strategy generalizable across an organization

• Guided decision making encourages consistency

• Pragmatic approach to record review

• Can focus on high risk areas

• Standardized methodology

• Rate of harm amenable to organizational monitoring

In general, there is widespread support for use

of trigger tools

Results: using trigger tools

6

Canadian Paediatric Adverse Events Study

• Used the CAPHC Paediatric Trigger Tool - rate, type,

severity, and preventability

• Compare adverse event epidemiology - academic

paediatric centres and community hospitals

9.2% of children hospitalized in Canada experience

adverse events

• Academic paediatric centres: more surgical AEs

• Community hospitals: more AEs related to clinical

management

Attention to surgical safety is the single most effective strategy

for improving overall safety for paediatric care in Canada

Part of the patient safety answer

Plan

Do

Act

Study

Research

Detect

Report

Train

& Learn

Improve

Process

Align Culture

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Filling the trigger tool gaps

8

Small sampleAnalytics approaches can sample

whole populations

20 minutes limits what you can findAutomation reduces the time to detect triggers to a few seconds

Medical record doesn’t contain all the information

Patient self report

Trigger tools don’t pick up all types of adverse events

Patient safety indicators, patient self report, additional big data analysis

Errors of omission missed by most trigger tools

Rules engines to identify missing pieces from known best practices

Coded data and indicators • Coded/structured data in trigger tools

• ICD-11

• Clustering, diagnostic timing indicators

• AHRQ patient safety indicators

• Hospital harm – CIHI and CPSI

• Hospital acquired conditions

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The data reality

10

OTN

AB

C

C

B C

K

K

K

S O

AS H

Alternate data reality

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The data opportunity

12

COLLECT

Clinical

Administrative

FOCUS DETECT

Potential adverse events

Other deviations from expected care

trajectories

Meaningful and Relevant Data

Points

CONFIRM

Qualify

Classify

COLLATE

Aggregate

Report

ANALYZE

Describe

Predict

PrescribeUnstructured

Coded

The ecosystem – are we ready?

• Data

• Culture

• Public needs and perceptions

13

https://www.england.nhs.uk/ourwork/tsd/care-data/

https://www.nih.gov/news-events/news-

releases/survey-shows-broad-support-national-

precision-medicine-study

….NHS England has taken the

decision to close the care.data

programme. https://www.england.nhs.uk/

ourwork/tsd/care-data/

http://www.zdnet.com/article/brandis-to-criminalise-

re-identifying-anonymous-data-under-privacy-act/

Use case: automated detection of triggers

Patient

admitted

Diagnosis Treatment

plan

Procedures &

Interventions

Patient

discharged

Data captured regarding care provided

34

25

16

Review & Classify

AE awareness and prevention

Adverse event detection

Automated identification

of IHI triggers

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Trigger tool automation demonstration

15

Trigger tool automation demonstration

16

Creating solutions

17

OCR

ECM

NLP, Analytics

Expanding the use case: real time detection of triggers

Patient

admitted

Diagnosis Treatment

plan

Procedures &

Interventions

Patient

discharged

Data captured regarding care provided

34

25

16

Review & Classify

AE awareness and prevention

Adverse event detection

Automated identification

of IHI triggers

18

Adverse event preventionD1 D2 D3

Contact Information

Camille Poulin PT, B.Sc.P.T., CPHIMS-CA, PMP

Director, Consulting

camille.poulin@cgi.com

780-409-5522

References1. Anne G Matlow, Catherine M G Cronin, Virginia Flintoft, Cheri Nijssen-Jordan, Mark Fleming, Barbara Brady-Fryer, Mary-Ann Hiltz, Elaine Orrbine, G Ross

Baker. Description of the development and validation of the Canadian Paediatric Trigger Tool, BMJ Qual Saf 2011;20:416e423.

doi:10.1136/bmjqs.2010.041152

2. Canadian Patient Safety Institute, Canadian Paediatric Adverse Events Study, 2013

3. Health Quality & Safety Commission. 2016. The global trigger tool: A review of the evidence (2016 edition). Wellington: Health Quality & Safety Commission.

4. Persephone Doupi, Karolina Peltomaa, Mika Kaartinen, Juha Öhman. IHI Global Trigger Tool and patient safety monitoring in Finnish hospitals - Current

experiences and future trends. 2013.

5. Schildmeijer K, Nilsson L, Perk J, et al. Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus

group interviews with team members. BMJ Open 2013;3:e003131. doi:10.1136/bmjopen-2013-003131

6. Griffin FA, Resar RK. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition). IHI Innovation Series white paper. Cambridge, Massachusetts:

Institute for Healthcare Improvement; 2009. (Available on www.IHI.org)

7. Department of Health and Human Services, Centers for Medicare & Medicaid Services: Adverse Drug Event Trigger Tool

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/Adverse-Drug-Event-Trigger-Tool.pdf

8. Agency for Healthcare Research and Quality – Patient Safety Indicators http://www.qualityindicators.ahrq.gov/modules/psi_overview.aspx

9. Ghali et al ICD-11 for quality and safety: overview of the who quality and safety topic advisory group. International Journal for Quality in Health Care 2013;

Volume 25, Number 6: pp. 621–625 10.1093/intqhc/mzt074.

10. Danielle A. Southern, Marc Hall, Deborah E. White, Patrick S. Roman, Vuaya Sundararajan, Saskia E. Droesler, Harold Pincus, William A. Ghali,

Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data. International Journal for

Quality in Health Care, 2015, 1–7. doi: 10.1093/intqhc/mzv096

11. Southern DA, Pincus HA, Romano PS, Burnand B, Harrison J, Forster AJ, Moskal L, Quan H, Droesler SE, Sundararajan V, Colin C, Gurevich Y, Brien SE,

Kostanjsek N, Üstün B, Ghali WA; World Health Organization ICD-11 Revision Topic Advisory Group on Quality & Safety; World Health Organization ICD-11

Revision Topic Advisory Group on Quality & Safety. Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International

Classification of Diseases (ICD-11).Int J Qual Health Care. 2016 Feb;28(1):136-42. doi: 10.1093/intqhc/mzv099. Epub 2015 Dec 10.

12. Canadian Institute for Health Information and Canadian Patient Safety Institute, Hospital Harm Project, https://www.cihi.ca/en/health-system-

performance/quality-of-care-and-outcomes/patient-safety/key-projects-on-patient-safety http://www.patientsafetyinstitute.ca/en/toolsResources/Hospital-

Harm-Measure/pages/default.aspx

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Supplemental

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NLP

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National Coordination Council for Medication Error Reporting and Prevention Index

for Categorizing Medication Errors