Patient safety monitoring in acute care in a decentralised national healthcare system: conceptual framework and initial set of actionable indicators

Objectives: Monitoring patient safety is critical for continuous qualityimprovement in acute care. We carried out a national project to identify aconceptual framework with core indicators that could be uniformly appliedin the decentralized health system of Italy.Methods: We used key international references to identify a frameworkwith a core list of indicators and data sources for calculation in 4 hospitals inthe Lombardy region. Two different data processing methods were applied:(a) centralized analysis of national databases and (b) decentralized data extractionand calculation using different hospital data available in Lombardy.Results: Agreement was reached on a conceptual framework for patientsafety monitoring in acute care, including structures, processes, and outcomesas vertical dimensions and health care needs as horizontal axes.We were able to compute 15 of 32 indicators through the application of arange of methods. The calculation of indicators using national databaseswas based on international standards. The consistency of the estimates obtainedthrough the use of different methods and data sources seemed limited.Conclusions: We successfully identified a conceptual framework for patientsafety in acute care including actionable indicators that can be calculatedroutinely using different data sources at national, regional, andhospital levels. Further work is required to compare methods and understandwhether a combination of strategies at national and local levels couldbe proven effective.