title: The orthopaedic error index: development and application of a novel national indicator for assessing the relative safety of hospital care using a cross-sectional approach.
abstract: OBJECTIVE
  The Orthopaedic Error Index for hospitals aims to provide the first national assessment of the relative safety of provision of orthopaedic surgery.
  
  
  METHODS
  Cross-sectional study (retrospective analysis of records in a database).
  
  
  METHODS
  The National Reporting and Learning System is the largest national repository of patient-safety incidents in the world with over eight million error reports. It offers a unique opportunity to develop novel approaches to enhancing patient safety, including investigating the relative safety of different healthcare providers and specialties.
  
  
  METHODS
  We extracted all orthopaedic error reports from the system over 1 year (2009-2010).
  
  
  METHODS
  The Orthopaedic Error Index was calculated as a sum of the error propensity and severity. All relevant hospitals offering orthopaedic surgery in England were then ranked by this metric to identify possible outliers that warrant further attention.
  
  
  RESULTS
  155 hospitals reported 48 971 orthopaedic-related patient-safety incidents. The mean Orthopaedic Error Index was 7.09/year (SD 2.72); five hospitals were identified as outliers. Three of these units were specialist tertiary hospitals carrying out complex surgery; the remaining two outlier hospitals had unusually high Orthopaedic Error Indexes: mean 14.46 (SD 0.29) and 15.29 (SD 0.51), respectively.
  
  
  CONCLUSIONS
  The Orthopaedic Error Index has enabled identification of hospitals that may be putting patients at disproportionate risk of orthopaedic-related iatrogenic harm and which therefore warrant further investigation. It provides the prototype of a summary index of harm to enable surveillance of unsafe care over time across institutions. Further validation and scrutiny of the method will be required to assess its potential to be extended to other hospital specialties in the UK and also internationally to other health systems that have comparable national databases of patient-safety incidents.
authors.affiliation: Department of Public Health, London Borough of Richmond Upon Thames, Richmond, UK.
authors.forename: Sukhmeet S
authors.initials: SS
authors.lastname: Panesar
authors.forename: Gopalakrishnan
authors.initials: G
authors.lastname: Netuveli
authors.forename: Andrew
authors.initials: A
authors.lastname: Carson-Stevens
authors.forename: Sundas
authors.initials: S
authors.lastname: Javad
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Patel
authors.forename: Gareth
authors.initials: G
authors.lastname: Parry
authors.forename: Liam J
authors.initials: LJ
authors.lastname: Donaldson
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
keywords: ORTHOPAEDIC & TRAUMA SURGERY; PUBLIC HEALTH