Patient Safety Indicators - Decubitus Ulcer - North West SHA

Relative Risk with 95% and 99.8% control limits

Select Acute Trust... Aintree Blackpool, Fylde & Wyre Central Manchester Countess Of Chester East Cheshire East Lancashire Lancashire Mid Cheshire Morecambe Bay North Cumbria Pennine Acute Royal Bolton Royal Liverpool & Broadgreen Salford Royal South Manchester Southport & Ormskirk St Helens & Knowsley Stockport Tameside Trafford Warrington & Halton Wirral Wrightington, Wigan & Leigh

X-axis: Expected Events, Y-axis: Relative Risk.

• Aintree

  Observed: 29

  Expected: 44.9

  Relative Risk: 64.6

• Blackpool, Fylde & Wyre

  Observed: 74

  Expected: 49.9

  Relative Risk: 148.1

• Central Manchester

  Observed: 67

  Expected: 44.2

  Relative Risk: 151.4

• Countess Of Chester

  Observed: 23

  Expected: 29.5

  Relative Risk: 78.0

• East Cheshire

  Observed: 15

  Expected: 17.2

  Relative Risk: 87.3

• East Lancashire

  Observed: 77

  Expected: 52.5

  Relative Risk: 146.6

• Lancashire

  Observed: 31

  Expected: 45.4

  Relative Risk: 68.3

• Mid Cheshire

  Observed: 13

  Expected: 22.2

  Relative Risk: 58.6

• North Cumbria

  Observed: 25

  Expected: 33.8

  Relative Risk: 74.1

• Pennine Acute

  Observed: 151

  Expected: 95.8

  Relative Risk: 157.7

• Royal Bolton

  Observed: 107

  Expected: 32.1

  Relative Risk: 332.9

• Royal Liverpool & Broadgreen

  Observed: 80

  Expected: 56.1

  Relative Risk: 142.6

• Salford Royal

  Observed: 69

  Expected: 34.1

  Relative Risk: 202.4

• Southport & Ormskirk

  Observed: 11

  Expected: 23.4

  Relative Risk: 47.0

• St Helens & Knowsley

  Observed: 53

  Expected: 36.2

  Relative Risk: 146.6

• Stockport

  Observed: 86

  Expected: 32.8

  Relative Risk: 262.2

• Tameside

  Observed: 15

  Expected: 23.6

  Relative Risk: 63.6

• Trafford

  Observed: 19

  Expected: 11.9

  Relative Risk: 160.1

• South Manchester

  Observed: 47

  Expected: 46.0

  Relative Risk: 102.3

• Morecambe Bay

  Observed: 38

  Expected: 39.0

  Relative Risk: 97.3

• Warrington & Halton

  Observed: 135

  Expected: 32.7

  Relative Risk: 413.4

• Wirral

  Observed: 67

  Expected: 45.0

  Relative Risk: 149.0

• Wrightington, Wigan & Leigh

  Observed: 42

  Expected: 37.8

  Relative Risk: 111.0

Relative Risk with 95% and 99.8% control limits

• Banding:
• Low
• Within expected
• High

Select Acute Trust... Aintree Blackpool, Fylde & Wyre Central Manchester Countess Of Chester East Cheshire East Lancashire Lancashire Mid Cheshire Morecambe Bay North Cumbria Pennine Acute Royal Bolton Royal Liverpool & Broadgreen Salford Royal South Manchester Southport & Ormskirk St Helens & Knowsley Stockport Tameside Trafford Warrington & Halton Wirral Wrightington, Wigan & Leigh

Caveat: Due to variations in secondary diagnosis coding it is difficult to know what the true national picture is, as some trusts are better at recording the information than others. The data is presented in this analysis in terms of 'High', 'Low' and 'Within expected' but it should be noted that a Trust labelled as 'High' may not actually have higher rates of incidents but are simply better at recording what happens.

Relative Risk with 95% and 99.8% control limits - SHA data

• Banding:
• Low
• Within expected
• High

Measure: Decubitus Ulcer Patient Safety Indicator

Description

The ratio of the observed number of cases of decubitus ulcer to the expected number, per all surgical and medical discharges with an operating room procedure.

Definition

Observed: Number of denominator spells with the ICD10 code for decubitus ulcer in any secondary field across the spell

Expected: The expected number of observed spells

Denominator: All surgical and medical spells in patients aged 19 and over where length of stay is at least 5 days, subject to certain exclusions.

Relative Risk: The observed numerator divided by the expected (multiplied by 100)

LCL: Lower 95% confidence limit

UCL: Upper 95% confidence limit

Banding: High - high number of observed events recorded (lower 95% confidence limit is greater than 100), Low - low number of observed events recorded (upper 95% confidence limit is lower than 100); Within Expected Range - as expected number of events recorded.

Technical definition

Observed: All spells with ICD10 code for decubitus ulcer in any secondary field across the spell.

ICD10 code: L89 Decubitus Ulcer

Expected:

The expected value for this indicator, calculated using a logistic regression model which adjusts for a variety of case-mix factors:

• Admission method
• Age group (5 year bands)
• Co-morbidities (based on the Charlson Score of the secondary diagnosis codes)
• Deprivation (Carstairs quintile)
• Sex

Denominator: All surgical and medical spells in patients aged 19 and over, defined by specific HRG and OPCS codes.

See Appendix A: Surgical HRGs. See Appendix B: Medical HRGs. See Appendix C: Derived Operating Room Procedures.

Exclude cases:

• With length of stay less than 5 days
• With ICD10 code of decubitus ulcer (see numerator) in the principal diagnosis field
• Any diagnosis of ICD10 codes for Hemiplegia, paraplegia, quadriplegia, spina bifida or anoxic brain damage across the spell.

ICD10 codes for Hemiplegia, paraplegia, quadriplegia, spina bifida or anoxic brain damage.

ICD10 code	Description
G801	Spastic diplegia
G802	Infantile hemiplegia
G808	Other infantile cerebral palsy
G809	Infantile cerebral palsy, unspecified
G810	Flaccid hemiplegia
G811	Spastic hemiplegia
G819	Hemiplegia, unspecified
G822	Paraplegia, unspecified
G825	Tetraplegia, unspecified
G830	Diplegia of upper limbs
G831	Monoplegia of lower limb
G832	Monoplegia of upper limb
G833	Monoplegia, unspecified
G834	Cauda equina syndrome
G838	Other specified paralytic syndromes
G839	Paralytic syndrome, unspecified
N319	Neuromuscular dysfunction of bladder, unspecified
G931	Anoxic brain damage, not elsewhere classified
G939	Disorder of brain, unspecified
G978	Other postprocedural disorders of nervous system

With an OPCS procedure code for debridement or pedicle graft op before or on the same day as the major operating room procedure (surgical cases only):

OPCS code	Description
T778	Other specified excision of muscle
S571	Debridement of skin NEC (includes excision of devitalised skin)
S573	Toilet of skin NEC
S17 + Y703	Distant flap of skin &muscle (first stage of staged operations NOC)
S18 + Y703	Distant flap of skin &fascia (first stage of staged operations NOC)
S19 + Y703	Distant pedicle flap of skin (first stage of staged operations NOC)
S24 + Y703	Local flap of skin &muscle (first stage of staged operations NOC)
S25 + Y703	Local flap of skin &fascia (first stage of staged operations NOC)
S26 + Y703	Local pedicle flap of skin (first stage of staged operations NOC)
S17 + Y713	Distant flap of skin &muscle (Revisional operations NOC)
S18 + Y713	Distant flap of skin &fascia (Revisional operations NOC)
S19 + Y713	Distant pedicle flap of skin (Revisional operations NOC)
S24 + Y713	Local flap of skin &muscle (Revisional operations NOC)
S25 + Y713	Local flap of skin &fascia (Revisional operations NOC)
S26 + Y713	Local pedicle flap of skin (Revisional operations NOC)
Admission source (ADMISORC) indicating long-term care
54	NHS run nursing home, residential care home or group home
85	Non-NHS (other than Local Authority) run residential care home (from 1996-97)
86	Non-NHS (other than Local Authority) run nursing home (from 1996-97)
88	non-NHS (other than Local Authority) run hospice
Transferred from acute care facility
Transfer (ADMIMETH=81 or ADMISORC=50-54) where previous trust is acute

Basis

NHS Acute (non-specialist) Trusts

Data sources & Time frame

February 2010 - January 2011

Secondary Uses Services (SUS) Commissioning Data set - non frozen SUS extract.

Data licence acknowledgments

Secondary Uses Services (SUS) - Hospital Admitted Patients - Copyright: Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.

Notes

Based on AHRQ PSI indicators

Translated by the Dr Foster Unit at Imperial College in collaboration with the Care Quality Commission (formerly the Healthcare Commission).