Quality of care indicators to support implementation of the Health Quality Fund in Romania: technical guidebook

Table of Contents

• Acknowledgements 7
• Abbreviations 8
• Background and scope 9
• 1.1 Introduction 10
• 1.2 Scope of the technical guidebook 11
• The Romanian health-care system in context 13
• 2.1 Health status and health priorities 14
• 2.2 Governance and organizational structure of the health-care system 14
• 2.3 Priorities for quality indicators 15
• Guiding principles for quality indicators, data collection and measurements 17
• 3.1 Introduction and overarching guiding principles 18
• 3.2 Development of QoC indicators and KPIs 21
• 3.3 Quality assurance 23
• 3.4 Information security, data protection and confidentiality 24
• Methodology for the Health Quality Fund indicators 25
• Good practice recommendations for patient safety indicators 69
• 5.1 CDC criteria for and definitions of BSIs and CLABSIs 70
• 5.2 CDC criteria for and definitions of VAEs 74
• 5.3 SSIs 78
• 5.4 Principles of patient blood management 84
• Good practice recommendations for clinical assessment procedures 85
• 6.1 Introduction to clinical auditing structures and functions 86
• 6.2 Procedures for clinical assessment for the Health Quality Fund indicators 87
• Final remarks 89
• References 91
• Annex 1. Central line-associated bloodstream infection (CLABSI) reporting tool 98
• Annex 2. Registration form for denominators for central line-associated bloodstream infection (CLABSI) and ventilator-associated event (VAE) 102
• Annex 3. Ventilator-associated event (VAE) reporting form 103
• Annex 4. Fall incident reporting form 106
• Annex 5. Pressure ulcer reporting form 108
• Annex 6. Example of surgical wound healing post-discharge questionnaire 111
• Annex 7. Surgical site infection (SSI) reporting form 113
• Annex 8. Quality from the patient’s perspective survey (QPPS) questionnaire, shortened 117
• Table 1. Data quality dimensions 19
• Table 2. Types of error and prevention measures 20
• Table 3. List of indicators 26
• Table 4. Indicator 1: central line-associated bloodstream infection rate 27
• Table 5. Indicator 2: ventilator-associated event rate 30
• Table 6. Indicator 3: percentage of in-hospital patients assessed for fall risk through applied protocols 32
• Table 7. Indicator 4: rate of patient falls during hospitalization 34
• Table 8. Indicator 5: percentage of in-hospital patients assessed for pressure ulcer risk through applied protocols 35
• Table 9. Indicator 6: rate of new pressure ulcers acquired during hospitalization 37
• Table 10. Indicator 7: percentage of patients undergoing surgery where the WHO Surgical Safety Checklist was applied 39
• Table 11. Indicator 8: postoperative bleeding rate requiring surgical re-intervention 41
• Table 12. Indicator 9: surgical site infection rate 43
• Table 13. Indicator 10: patient experience questionnaire completion rate 45
• Table 14. Indicator 11: patient experience after hospital discharge average score 46
• Table 15. Indicator 12: percentage of health-care workers participating in QoC and patient safety training activities 47
• Table 16. Indicator 13: percentage of health-care workers who followed standard protocol for occupational health following a sharps injury during working hours 49
• Table 17. Indicator 14: percentage of health-care workers immunized against influenza during the current vaccination season 50
• Table 18. Indicator 15: in-hospital mortality among patients with heart failure 51
• Table 19. Indicator 16: in-hospital mortality among patients with acute myocardial infarction 53
• Table 20. Indicator 17: in-hospital mortality among patients with pneumonia 55
• Table 21. Indicator 18: percentage of patients readmitted to the ICU within 48 hours of transfer 57
• Table 22. Indicator 19: percentage of unscheduled readmissions to hospital within 30 days of discharge for heart failure through the emergency department 58
• Table 23. Indicator 20: average length of hospitalization (hospital stay) 60
• Table 24. Indicator 21: percentage of surgical procedures with a perioperative hospital length of stay of less than 48 hours 61
• Table 25. Indicator 22: preoperative hospital length of stay for elective surgery 62
• Table 26. Indicator 23: percentage of cancer patients assessed for nutritional status through applied protocols 63
• Table 27. Indicator 24: in-hospital mortality among patients with ischaemic stroke 65
• Table 28. Indicator 25: average time from admission to treatment (“door-to-needle time”) for ischaemic stroke 67
• Table 29. LCBI criteria 70
• Table 30. MBI-LCBI criteria 71
• Table 31. Examples of reporting timelines at the facility level 80
• Table 32. Examples of reporting timelines at the national level 80
• Table 33. Superficial incisional SSI criteria 81
• Table 34. Deep incisional SSI criteria 82
• Table 35. Organ/space SSI criteria 82
• Fig. 1. Classification of QoC indicators and KPIs 22
• Fig. 2. CLABSI flowchart 73
• Fig. 3. VAE flowchart 76
• Fig. 4. Data assessment flowchart 88