The Development of Patient Safety Indicators for Critically Ill Patients Admitted to the Intensive Care Unit

Wu, Guosong

The Development of Patient Safety Indicators for Critically Ill Patients Admitted to the Intensive Care Unit

dc.contributor.advisor	Stelfox, Henry Thomas
dc.contributor.advisor	Wu, Qunhong
dc.contributor.advisor	Quan, Hude
dc.contributor.author	Wu, Guosong
dc.contributor.committeemember	Ronksley, Paul Everett
dc.contributor.committeemember	Holroyd-Leduc, Jayna M.
dc.date	2020-11
dc.date.accessioned	2020-07-13T15:07:38Z
dc.date.available	2020-07-13T15:07:38Z
dc.date.issued	2020-07-09
dc.description.abstract	Patient safety is a top priority in critical care. Patient safety indicators (PSIs) have been developed to measure critical care safety. Despite several approaches have been used to develop PSIs (deductive, inductive, and joint approach), PSIs are widely applied to measure the care performance in Intensive Care Units (ICUs). The overall objective of this thesis was to use a joint approach to develop a PSI that can be used to evaluate the safety of critical care and to assess the reliability and validity of this PSI. Three studies were conducted to achieve this objective. In the first study, we systematically reviewed the literature of PSIs proposed for patients admitted to an ICU. Heterogeneity of PSI definitions were observed. Among 44 unique PSIs identified from 21 studies, reliability and validity of four PSIs was only reported in one study. In the second study, a panel of ICU experts evaluated the 44 unique PSIs identified in our systematic review. The expert panel proposed an additional 20 PSIs and, during a second round, evaluated and prioritized the 64 PSIs using a modified RAND Appropriateness Method. The top ten ranked PSIs included clinically important concepts that had data available in a local electronic database. This included patient falls, which we investigated in our final study. In the third study, we constructed a fall risk predictive model leveraging provincial electronic medical record (EMR) and examined its reliability and validity. Overall, fall incidence rate was 1.55 (95% CI 1.36-1.76) per 1,000 patient days. The model displayed an excellent discrimination (AUC 0.82) and calibration. We propose the definition of Risk-adjusted Standardized Fall Rate (RSFR) to compared critical care performance across sites and overtime in order to test effectiveness of quality improvement strategies. RSFR demonstrates good test re-test reliability (r=0.662) and construct validity (r=0.533). The study proposed PSI for patient falls was developed from a comprehensive systematic review of the literature, structured expert panel review of candidate PSIs, and validated using a local EMR database. The main findings of this thesis support RSFR could be measured and monitored provincially or nationally to benchmark critical care safety performance.	en_US
dc.identifier.citation	Wu, G. (2020). The Development of Patient Safety Indicators for Critically Ill Patients Admitted to the Intensive Care Unit (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.	en_US
dc.identifier.doi	http://dx.doi.org/10.11575/PRISM/38009
dc.identifier.uri	http://hdl.handle.net/1880/112289
dc.language.iso	eng	en_US
dc.publisher.faculty	Cumming School of Medicine	en_US
dc.publisher.institution	University of Calgary	en
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.	en_US
dc.subject	Patient Safety Indicator	en_US
dc.subject	Intensive Care Medicine	en_US
dc.subject	Care Quality	en_US
dc.subject.classification	Education--Health	en_US
dc.title	The Development of Patient Safety Indicators for Critically Ill Patients Admitted to the Intensive Care Unit	en_US
dc.type	doctoral thesis	en_US
thesis.degree.discipline	Medicine – Community Health Sciences	en_US
thesis.degree.grantor	University of Calgary	en_US
thesis.degree.name	Doctor of Philosophy (PhD)	en_US
ucalgary.item.requestcopy	true	en_US