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Current Pharmaceutical Biotechnology

Editor-in-Chief

ISSN (Print): 1389-2010
ISSN (Online): 1873-4316

Research Article

Advanced Loss Eventuality Assessment and Technical Estimates: An Integrated Approach for Management of Healthcare-Associated Infections

Author(s): Vittorio Gatto, Matteo Scopetti, Raffaele La Russa*, Alessandro Santurro, Luigi Cipolloni, Rocco V. Viola, Mariantonia Di Sanzo, Paola Frati and Vittorio Fineschi

Volume 20, Issue 8, 2019

Page: [625 - 634] Pages: 10

DOI: 10.2174/1389201020666190408095050

Price: $65

Abstract

Background: Healthcare Associated Infections (HAIs) represent a crucial issue in health and patient safety management due to the persistent nature, economic impact and possible preventability of the phenomenon. Compensation claims for damages resulting from HAI could provide insights that can improve the understanding of suboptimal steps in the therapeutic process, enable an estimate of costs related to infectious complications, and guide the development of planning tools for implementation of the quality of care.

Objective: This paper analyzes all the HAI claims received at the Umberto I General Hospital of Rome across a five-year period with the aim of outlining a methodological approach to the litigation management and of characterizing the economic impact of infections on health facilities resources.

Methods: All claims received during the study period have been classified according to the International Classification for Patient Safety (ICPS) system. Subsequently, claims related to Healthcare Associated Infections were evaluated through an innovative tool for determination of the risk of loss, the Advanced Loss Eventuality Assessment (ALEA) score.

Results: The results obtained demonstrate the relevance of a correct management of HAI claims in the administration of a health care system. Specifically, the cases examined during the study highlighted the significant impact of infectious diseases of a nosocomial nature in terms of frequency and economic exposure.

Conclusion: The proposed methodological approach allows a productive analysis of the internal processes, providing fundamental data for the refinement of the preventive strategies and for the rationalization of the resources through the expenditure forecasts.

Article Highlights Box: Healthcare-Associated Infections represent an essential element to consider in the management of health facilities.

• Many studies highlight the economic burden of Healthcare-Associated Infections in health policies.

• Litigation management represents a useful resource in the prevention of Healthcare Associated Infections.

• Appropriate clinical risk management policies in the field of Healthcare-Associated Infections allow the implementation of preventive measures, the reduction of the incidence of the phenomenon and the quality of care.

• The costs of Healthcare-Associated Infections can be limited through a systematic methodological approach based on Advanced Loss Eventuality Assessment and technical estimate of the value of each case.

• The application of a standardized system would be desirable in any health facility despite the potential methodological, technical, behavioral and financial issues.

Keywords: Healthcare-associated infections, litigation management, HAI claims, ALEA score, technical estimates, cost analysis, quality of health care, patient safety.

Graphical Abstract

[1]
The National Quality Forum.. Safe practices for better healthcare - 2010 update: A consensus report. National Quality Forum, 2010.
[2]
Pawlson, L.G.; O’Kane, M.E. Malpractice prevention, patient safety, and quality of care: A critical linkage. Am. J. Manag. Care, 2004, 10(4), 281-284.
[3]
Mirzoev, T.; Kane, S. Key strategies to improve systems for managing patient complaints within health facilities - what can we learn from the existing literature? Glob. Health Action, 2018, 11(1)1458938
[4]
Hsieh, S.Y. The use of patient complaints to drive quality improvement: an exploratory study in Taiwan. Health Serv. Manage. Res., 2010, 23(1), 5-11.
[5]
Bates, D.W.; Larizgoitia, I.; Prasopa-Plaizier, N.; Jha, A.K. Research Priority Setting Working Group of the WHO World Alliance for Patient Safety. Global priorities for patient safety research. BMJ, 2009, 338, b1775.
[6]
Burke, J.P. Infection control - a problem for patient safety. N. Engl. J. Med., 2003, 348(7), 651-656.
[7]
Ducel, G.; Fabry, J.; Nicolle, L.; Girard, R.; Perraud, M.; Prüss, A.; Savey, A.; Tikhomirov, E.; Thuriaux, M.; Vanhems, P. Prevention of hospital-acquired infections: A practical guide; World Health Organization, 2002.
[8]
Gastmeier, P.; Geffers, C.; Brandt, C.; Zuschneid, I.; Sohr, D.; Schwab, F.; Behnke, M.; Daschner, F.; Rüden, H. Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J. Hosp. Infect., 2006, 64(1), 16-22.
[9]
European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. European Centre for Disease Prevention and Control, 2013.
[10]
European Centre for Disease Prevention and Control. Annual Epidemiological Report 2012. Reporting on 2010 surveillance data and 2011 epidemic intelligence data. European Centre for Disease Prevention and Control, 2013.
[11]
Kohn, L.T.; Corrigan, J.M.; Donaldson, M.S. Institute of Medicine (US) Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System; National Academies Press: Washington, 2000.
[12]
Al-Tawfiq, J.A.; Tambyah, P.A. Healthcare associated infections (HAI) perspectives. J. Infect. Public Health, 2014, 7(4), 339-344.
[13]
Jha, A.K.; Chan, D.C.; Ridgway, A.B.; Franz, C.; Bates, D.W. Improving safety and eliminating redundant tests: Cutting costs in US hospitals. Health Aff. (Millwood), 2009, 28(5), 1475-1484.
[14]
National Quality Forum. Safe practices for better healthcare: 2010 update.. http://www.qualityforum.org/Projects/Safe_Practices_2010.aspx (Accessed June 14, 2018).
[15]
Truskett, P. Should we view patient complaints as a resource? ANZ J. Surg., 2012, 82(10), 667.
[16]
Jonsson, P.M.; Øvretveit, J. Patient claims and complaints data for improving patient safety. Int. J. Health Care Qual. Assur., 2008, 21(1), 60-74.
[17]
Øvretveit, J.; Klazinga, N. Guidance on developing quality and safety strategies with a health system approach; World Health Organization, 2008.
[18]
Pichert, J.W.; Moore, I.N.; Karrass, J.; Jay, J.S.; Westlake, M.W.; Catron, T.F.; Hickson, G.B. An intervention model that promotes accountability: Peer messengers and patient/family complaints. Jt. Comm. J. Qual. Patient Saf., 2013, 39(10), 435-446.
[19]
Sun, X.; Faunce, T. Decision-analytical modelling in health-care economic evaluations. Eur. J. Health Econ., 2008, 9(4), 313-323.
[20]
Lisboa, T.; Rello, J. Towards zero rate in healthcare-associated infections: One size shall not fit all. Crit. Care, 2013, 17(3), 139.
[21]
Harbarth, S.; Sax, H.; Gastmeier, P. The preventable proportion of nosocomial infections: an overview of published reports. J. Hosp. Infect., 2003, 54(4), 258-266.
[22]
Umscheid, C.A.; Mitchell, M.D.; Doshi, J.A.; Agarwal, R.; Williams, K.; Brennan, P.J. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect. Control Hosp. Epidemiol., 2011, 32(2), 101-114.
[23]
Safdar, N.; Anderson, D.J.; Braun, B.I.; Carling, P.; Cohen, S.; Donskey, C.; Drees, M.; Harris, A.; Henderson, D.K.; Huang, S.S.; Juthani-Mehta, M.; Lautenbach, E.; Linkin, D.R.; Meddings, J.; Miller, L.G.; Milstone, A.; Morgan, D.; Sengupta, S.; Varman, M.; Yokoe, D.; Zerr, D.M. Research Committee of the Society for Healthcare Epidemiology of America. Infect. Control Hosp. Epidemiol., 2014, 35(5), 480-493.
[24]
Clancy, C.M. Getting to zero: our effort to eliminate infections nationwide. J. Nurs. Care Qual., 2010, 25(3), 189-192.
[25]
Agency for Healthcare Research and Quality (AHRQ). Fact Sheet - AHRQ’s Efforts to Prevent and Reduce Healthcare-Associated Infections.. https://archive.ahrq.gov/research/findings/factsheets/errors-safety/haiflyer/haiflyer.pdf (Accessed June 12, 2018).
[26]
Boncagni, F.; Francolini, R.; Nataloni, S.; Skrami, E.; Gesuita, R.; Donati, A.; Pelaia, P. Epidemiology and clinical outcome of healthcare-associated infections: A 4- year experience of an Italian ICU. Minerva Anestesiol., 2015, 81(7), 765-775.
[27]
Burgmann, H.; Hiesmayr, J.M.; Savey, A.; Bauer, P.; Metnitz, B.; Metnitz, P.G. Impact of nosocomial infections on clinical outcome and resource consumption in critically ill patients. Intensive Care Med., 2010, 36(9), 1597-1601.
[28]
Thursky, K.; Lingaratnam, S.; Jayarajan, J.; Haeusler, G.M.; The, B.; Tew, M.; Venn, G.; Hiong, A.; Brown, C.; Leung, V.; Worth, L.J.; Dalziel, K.; Slavin, M.A. Implementation of a whole of hospital sepsis clinical pathway in a cancer hospital: Impact on sepsis management, outcomes and costs. BMJ Open Qual., 2018, 7(3)e000355
[29]
Agodi, A.; Auxilia, F.; Barchitta, M.; Brusaferro, S.; D’Alessandro, D.; Grillo, O.C.; Montagna, M.T.; Pasquarella, C.; Righi, E.; Tardivo, S.; Torregrossa, V.; Mura, I. GISIO-SITI. Trends, risk factors and outcomes of healthcare-associated infections within the Italian network SPIN-UTI. J. Hosp. Infect., 2013, 84(1), 52-58.
[30]
Siempos, I.I.; Kopterides, P.; Tsangaris, I.; Dimopoulou, I.; Armaganidis, A.E. Impact of catheter-related bloodstream infections on the mortality of critically ill patients: A meta-analysis. Crit. Care Med., 2009, 37(7), 2283-2289.
[31]
Bekaert, M.; Timsit, J.F.; Vansteelandt, S.; Depuydt, P.; Vésin, A.; Garrouste-Orgeas, M.; Decruyenaere, J.; Clec’h, C.; Azoulay, E.; Benoit, D. Outcomerea Study Group. Attributable mortality of ventilator-associated pneumonia: A reappraisal using causal analysis. Am. J. Respir. Crit. Care Med., 2011, 184(10), 1133-1139.
[32]
Eber, M.R.; Laxminarayan, R.; Perencevich, E.N.; Malani, A. Clinical and economic outcomes attributable to health care-associated sepsis and pneumonia. Arch. Intern. Med., 2010, 170(4), 347-353.
[33]
Stone, P.W. Economic burden of healthcare-associated infections: An American perspective. Expert Rev. Pharmacoecon. Outcomes Res., 2009, 9(5), 417-422.
[34]
Stone, P.W.; Braccia, D.; Larson, E. Systematic review of economic analyses of health care-associated infections. Am. J. Infect. Control, 2005, 33(9), 501-509.
[35]
Zimlichman, E.; Henderson, D.; Tamir, O.; Franz, C.; Song, P.; Yamin, C.K.; Keohane, C.; Denham, C.R.; Bates, D.W. Health care-associated infections: A meta-analysis of costs and financial impact on the US health care system. JAMA Intern. Med., 2013, 173(22), 2039-2046.
[36]
Klevens, R.M.; Edwards, J.R.; Richards, C.L., Jr; Horan, T.C.; Gaynes, R.P.; Pollock, D.A.; Cardo, D.M. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep., 2007, 122(2), 160-166.
[37]
European Centre for Disease Prevention and Control. Annual epidemiological report on communicable diseases in Europe 2008. Report on the state of communicable diseases in the EU and EEA/EETA countries. European Centre for Disease Prevention and Control, 2008.
[38]
Vincent, J.L. Nosocomial infections in adult intensive-care units. Lancet, 2003, 361(9374), 2068-2077.
[39]
Vincent, J.L.; Bihari, D.J.; Suter, P.M.; Bruining, H.A.; White, J.; Nicolas-Chanoin, M.H.; Wolff, M.; Spencer, R.C.; Hemmer, M. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) study. EPIC International Advisory Committee. JAMA, 1995, 274(8), 639-644.
[40]
Hugonnet, S.; Eggimann, P.; Borst, F.; Maricot, P.; Chevrolet, J.C.; Pittet, D. Impact of ventilator-associated pneumonia on resource utilization and patient outcome. Infect. Control Hosp. Epidemiol., 2004, 25(12), 1090-1096.
[41]
Safdar, N.; Dezfulian, C.; Collard, H.R.; Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit. Care Med., 2005, 33(10), 2184-2193.
[42]
O’Grady, N.P.; Alexander, M.; Burns, L.A.; Dellinger, E.P.; Garland, J.; Heard, S.O.; Lipsett, P.A.; Masur, H.; Mermel, L.A.; Pearson, M.L.; Raad, I.I.; Randolph, A.G.; Rupp, M.E.; Saint, S. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin. Infect. Dis., 2011, 52(9), e162-e193.
[43]
Bishop, T.F.; Ryan, A.M.; Casalino, L.P. Paid malpractice claims for adverse events in inpatient and outpatient settings. JAMA, 2011, 305(23), 2427-2431.
[44]
Bonetti, M.; Cirillo, P.; Musile Tanzi, P.; Trinchero, E. An analysis of the number of medical malpractice claims and their amounts. PLoS One, 2016, 11(4)e0153362
[45]
McKibben, L.; Horan, T.; Tokars, J.I.; Fowler, G.; Cardo, D.M.; Pearson, M.L.; Brennan, P.J. Healthcare Infection Control Practices Advisory Committee. Guidance on public reporting of healthcareassociated infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee. Infect. Control Hosp. Epidemiol., 2005, 26(6), 580-587.
[46]
Haustein, T.; Gastmeier, P.; Holmes, A.; Lucet, J.C.; Shannon, R.P.; Pittet, D.; Harbarth, S. Use of benchmarking and public reporting for infection control in four high-income countries. Lancet Infect. Dis., 2011, 11(6), 471-481.
[47]
Javetz, R.; Stern, Z. Patients’ complaints as a management tool for continuous quality improvement. J. Manag. Med., 1996, 10(3), 39-48.
[48]
Hsieh, S.Y. Using complaints to enhance quality improvement: Developing an analytical tool. Int. J. Health Care Qual. Assur., 2012, 25(5), 453-461.
[49]
Greve, P.A., Jr Anticipating and controlling rising malpractice insurance costs. Healthc. Financ. Manage., 2002, 56(5), 50-55.
[50]
Yokoe, D.S.; Anderson, D.J.; Berenholtz, S.M.; Calfee, D.P.; Dubberke, E.R.; Ellingson, K.D.; Gerding, D.N.; Haas, J.P.; Kaye, K.S.; Klompas, M.; Lo, E.; Marschall, J.; Mermel, L.A.; Nicolle, L.E.; Salgado, C.D.; Bryant, K.; Classen, D.; Crist, K.; Deloney, V.M.; Fishman, N.O.; Foster, N.; Goldmann, D.A.; Humphreys, E.; Jernigan, J.A.; Padberg, J.; Perl, T.M.; Podgorny, K.; Septimus, E.J.; VanAmringe, M.; Weaver, T.; Weinstein, R.A.; Wise, R.; Maragakis, L.L. Society for Healthcare Epidemiology of America (SHEA). A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect. Control Hosp. Epidemiol., 2014, 35(8), 967-977.
[51]
Ranji, S.R.; Shetty, K.; Posley, K.A.; Lewis, R.; Sundaram, V.; Galvin, C.M.; Winston, L.G. Prevention of healthcare-associated infections. Agency Healthcare Res. Qual., 2007.AHRQ Publication No. 04(07)-0051-6..
[52]
Scott, D.R. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf (Accessed June 7, 2018).
[53]
Magill, S.S.; Edwards, J.R.; Bamberg, W.; Beldavs, Z.G.; Dumyati, G.; Kainer, M.A.; Lynfield, R.; Maloney, M.; McAllister-Hollod, L.; Nadle, J.; Ray, S.M.; Thompson, D.L.; Wilson, L.E.; Fridkin, S.K. Emerging infections program healthcare-associated infections and antimicrobial use prevalence survey team. Multistate point-prevalence survey of health care-associated infections. N. Engl. J. Med., 2014, 370(13), 1198-1208.
[54]
van der Wal, G.; Lens, P. Handling complaints in hospitals. Health Policy, 1994, 31(1), 17-27.
[55]
Cowan, J.; Anthony, S. Problems with complaint handling: expectations and outcomes. Clin. Governance: Int. J., 2008, 13(2), 164-168.
[56]
van Bunnik, B.A.; Ciccolini, M.; Gibbons, C.L.; Edwards, G.; Fitzgerald, R.; McAdam, P.R.; Ward, M.J.; Laurenson, I.F.; Woolhouse, M.E. Efficient national surveillance for health-care-associated infections. BMC Public Health, 2015, 15, 832.
[57]
Mitchell, B.G.; Russo, P.L. Preventing healthcare-associated infections: The role of surveillance. Nurs. Stand., 2015, 29(23), 52-58.
[58]
Gastmeier, P. Surveillance of nosocomial infections. Ther. Umsch., 2004, 61(3), 204-209.
[59]
Centers for Disease Control and Prevention. Monitoring hospitalacquired infections to promote patient safety - United States, 1990- 1999. MMWR Morb. Mortal. Wkly. Rep., 2000, 49(8), 149-153.
[60]
Platt, R.; Yokoe, D.S.; Sands, K.E. Automated methods for surveillance of surgical site infections. Emerg. Infect. Dis., 2001, 7(2), 212-216.
[61]
Weigelt, J.A.; Dryer, D.; Haley, R.W. The necessity and efficiency of wound surveillance after discharge. Arch. Surg., 1992, 127(1), 77-81.
[62]
Samore, M.H.; Evans, R.S.; Lassen, A.; Gould, P.; Lloyd, J.; Gardner, R.M.; Abouzelof, R.; Taylor, C.; Woodbury, D.A.; Willy, M.; Bright, R.A. Surveillance of medical device-related hazards and adverse events in hospitalized patients. JAMA, 2004, 291(3), 325-334.
[63]
O’Neill, E.; Humphreys, H. Use of surveillance data for prevention of healthcare-associated infection: Risk adjustment and reporting dilemmas. Curr. Opin. Infect. Dis., 2009, 22(4), 359-363.
[64]
Emori, T.G.; Culver, D.H.; Horan, T.C.; Jarvis, W.R.; White, J.W.; Olson, D.R.; Banerjee, S.; Edwards, J.R.; Martone, W.J.; Gaynes, R.P.; Hughes, J.M. National nosocomial infections surveillance system (NNIS): Description of surveillance methods. Am. J. Infect. Control, 1991, 19(1), 19-35.
[65]
Suetens, C.; Morales, I.; Savey, A.; Palomar, M.; Hiesmayr, M.; Lepape, A.; Gastmeier, P.; Schmit, J.C.; Valinteliene, R.; Fabry, J. European Surveillance of ICU-Acquired Infections (HELICS-ICU): Methods and main results. J. Hosp. Infect., 2007, 65(2), 171-173.
[66]
Wilson, J.; Ramboer, I.; Suetens, C. Hospitals in Europe Link for Infection Control through Surveillance (HELICS). Inter-country comparison of rates of surgical site infection - opportunities and limitations. J. Hosp. Infect., 2007, 65(2), 165-170.
[67]
Mello, M.M.; Studdert, D.M. Building a national surveillance system for malpractice claims. Health Serv. Res., 2016, 51(3), 2642-2648.
[68]
Bismark, M.M.; Studdert, D.M. Realising the research power of complaints data. N. Z. Med. J., 2010, 123(1314), 12-17.
[69]
Mu, Y.; Edwards, J.R.; Horan, T.C.; Berrios-Torres, S.I.; Fridkin, S.K. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect. Control Hosp. Epidemiol., 2011, 32(10), 970-986.
[70]
Järvelin, J.; Häkkinen, U. Can patient injury claims be utilised as a quality indicator? Health Policy, 2012, 104(2), 155-162.
[71]
Smith, P.C.; Mossialos, E.; Leatherman, S.; Papanicolas, I. Performance measurement for health system improvement - Experiences, challenges and prospects; Cambridge University Press: Cambridge, 2009.
[72]
Jonsson, P.M.; Øvretveit, J. Patient claims and complaints data for improving patient safety. Int. J. Health Care Qual. Assur., 2008, 21(1), 60-74.
[73]
Levin, C.M.; Hopkins, J. Creating a patient complaint capture and resolution process to incorporate best practices for patient-centered representation. Jt. Comm. J. Qual. Patient Saf., 2014, 40(11), 484-492.
[74]
Hsieh, S.Y. A system for using patient complaints as a trigger to improve quality. Qual. Manag. Health Care, 2011, 20(4), 343-355.
[75]
Simmons, J.C. How root-cause analysis can improve patient safety. Qual. Lett. Healthc. Lead., 2001, 13(10), 2-12.
[76]
Landrigan, C.P.; Parry, G.J.; Bones, C.B.; Hackbarth, A.D.; Goldmann, D.A.; Sharek, P.J. Temporal trends in rates of patient harm resulting from medical care. N. Engl. J. Med., 2010, 363(22), 2124-2134.

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