Heropnamen? Aan de slag!

Transcriptie

1 VEVIGHEID IN DE ZORG V Heropnamen? Aan de slag! Jan Klein Anesthesioloog Hoogleraar Patient Safety Engineering 1

2 A quality indicator should not use the total amount of readmissions, but should solely address the ones which are preventable. This could provide us with a more honest and goal-directed way to assess the quality in hospitals. HOSPITAL READMISSIONS: A RELIABLE QUALITY INDICATOR? Louise S. van Galen Prabath W.B. Nanayakkara Ned Tijdschr Geneeskd 2016;160:A9885 2

3 Indicator Heropnamen Internationale literatuur laat zien dat 9-40% (gepoold 23%) van de heropnames waarschijnlijk vermijdbaar is Van Walraven C, Jennings A, Forster AJ. A meta-analysis of hospital 30-day avoidable readmission rates. J Eval Clin Pract. 2012;18:

4 Indicator Heropnamen Kans van 83 procent kans om te overleven Ik heb een kans van een zesde om te overlijden 4

5 However, the question remains if it wouldn t be more beneficial to drop this indicator in total. HOSPITAL READMISSIONS: A RELIABLE QUALITY INDICATOR? Louise S. van Galen Prabath W.B. Nanayakkara Ned Tijdschr Geneeskd 2016;160:A9885 5

6 Wat nu? Aan de slag! 6

7 In our vision, in every hospital, regardless the preventability, it should be natural to investigate the causes for each individual readmission that has returned back to hospital unintentionally within 30 days after discharge. HOSPITAL READMISSIONS: A RELIABLE QUALITY INDICATOR? Louise S. van Galen Prabath W.B. Nanayakkara Ned Tijdschr Geneeskd 2016;160:A9885 7

8 Oorzaken-onderzoek Tel het aantal ongeplande heropnames in uw ziekenhuis Gemiddeld per ziekenhuis per jaar, dat is 6 per dag Classificeer ze naar type, want de ene heropname is de andere niet 8

9 Welke classificatie? 9

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11 Classificatie heropnames A. Complicaties A. Verwacht maar onvoorspelbaar A. Voorkeur A. Artefact A. Ongeval of ander orgaansysteem A. Diagnose gerelateerd 11

12 Oorzaken-onderzoek Tel het aantal ongeplande heropnames in uw ziekenhuis Gemiddeld per ziekenhuis per jaar, dat is 6 per dag Classificeer ze naar type, want de ene heropname is de andere niet Doe oorzaken-onderzoek per type en per multidisciplinair team 12

13 OORZAKEN ONDERZOEK : VEILIGHEIDSDENKEN 13

14 Criticism on System Theory Our technologies are increasingly complex, emergent and non-linear. Or they get released into environments that make them complex, emergent and non-linear. Sidney Dekker (2011) in: Drift into Failure 14

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23 Criticism on System Theory No direct causal and sequential relationship between risks and adverse events; non-linear relationship 23

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25 Criticism on System Theory 25

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27 Criticism on System Theory Makes insufficient use of problem solving capacity health care professionals 27

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29 Criticism on System Theory Improvements characterized as top down, evidence-based, bureaucratic (rules, guidelines and checklists) 29

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32 COMPLEXITY Science is not value-free nor objective Specific efforts, specific interests, limited perspectives, ethical implications, etc Thus view from nowhere does not exist Order out of Chaos Prigogine & Stengers (1984) 32

33 Complexity 33

34 AANTAL 34

35 CONNECTIVITEIT 35

36 ADAPTATIE 36

37 DIVERSITEIT 37

38 COMPLEXITY Safety is not a stable entity you can map and subsequently fill the gaps by science But: continuous flux, emergent, layered, changing patterns, interactions and reactions Order out of Chaos Prigogine & Stengers (1984) 38

39 Oorzaken-onderzoek 39

40 Contrasting Models on Safety Replace / support professionals Professionals create safety Technical solutions Design and standardization Protocols and guidelines Information technology Measurement and classification Safety Investigation tools System theory Teamwork and leadership Culture of a high reliability organization Mindfulness and risk awareness Training and resilience Learning Diversity in narratives Complexity theory 40

41 Safety = Balancing system theory and complexity theory 41

42 Contrasting Models on Safety Replace / support professionals Professionals create safety Technical solutions Design and standardization Protocols and guidelines Information technology Measurement and classification Safety Investigation tools System theory Teamwork and leadership Culture of a high reliability organization Mindfulness and risk awareness Training and resilience Learning Diversity in narratives Complexity theory 42

43 Diversity as a Safety Value With diversity, a system has a larger number of perspectives to view a problem with and a larger repertoire of possible responses Dekker (2011) in: Drift into failure 43

44 Rir 44