After a two-year hiatus in collecting healthcare quality and safety indicators (IQSS) from healthcare establishments due to the Covid-19 pandemic, the Haute Autorité de santé (HAS) is publishing the results for the year 2022. For the first time, indicators have been measured in psychiatry concerning the somatic management of patientsconsidered insufficient.
At the beginning of 2023, both in the form of national reports and on QualiScope, the HAS presents the results of 30 healthcare quality and safety indicators at the national level concerning four sectors: medicine, surgery, obstetrics (MCO) , follow-up and rehabilitation care (SSR), home hospitalization (HAD) and, for the first time, general psychiatry (PSY).
Developed with healthcare professionals and patients and regularly updated, these indicators make it possible to measure patient satisfaction and experience, and to assess quality on specific points of clinical management, coordination between professionals and the prevention of healthcare-associated infections, to enable each healthcare establishment to define the necessary improvement actions. These indicators, which do not currently identify the problems of access to care, are therefore not intended to draw up an exhaustive inventory of the quality of the hospital system.
Points of fragility and weak signals that warn of a possible beginning of deterioration in the quality of care
In general, and despite everyone’s commitment, some results do not increase enough, and for some have settled since their last measurement, most of them carried out more than two years ago.. Collected on a very large number of files, the indicators are not very sensitive to variations. Small-scale regressions can therefore be the sign of real changes, especially since this is the first time that we have observed them.
- So the quality of pain assessment and management regresses for the first time in SSR (even if it remains at high level) . Similarly, in MCO, there is a slightly larger proportion of establishments for which the occurrence of surgical site infections following the fitting of a total hip or knee prosthesis is higher than expected. taking into account the risk profile of the patients treated. And in HAH, the indicator measuring the correct assessment of the risk of pressure ulcers in patients is also down, while remaining at a high level.
- Central element of city/hospital coordination, the transmission and quality of the liaison letter on leaving the establishment are improving. Nevertheless, the results remain far below the objectives in all the sectors where the indicator is measured; and in particular in MCO, where only 31% of establishments reach a satisfactory level, with a notable weakness in the mention of medical treatment at discharge.
- Regarding the prevention of healthcare-associated infections, controlling the spread of bacteria that are multi-resistant to antibiotics and microorganisms with a high potential for cross-transmission represents a real public health challenge. Nevertheless, only 19% of establishments reach a satisfactory level for the indicator “good practices in additional contact precautions” in the MCO sector, a result mainly linked to a lack of information for the patients concerned.
and in psychiatry…
For the first time, indicators were measured in psychiatry (full-time hospitalization). They target the somatic management of patients, essential but too often left aside in favor of the sole management of psychiatric disorders. The results are insufficient in this sector. They allow the teams to have a point of reference to situate their practices and identify the margins of improvement, for example on the identification and the proposal of help to stop addictions in adults, or on the cardiovascular and metabolic assessmente.
Overall, the results of the 2022 IQSS campaign reflect the mobilization of the teams as soon as a patient is hospitalized and their ability to be part of a dynamic of continuous improvement of care. Nevertheless, weak signals exist, which must be taken into consideration and monitored.. The HAS therefore wishes to engage in reflection with its institutional partners, on new measurement tools allowing in particular to assess the level of access to care in the territory and to support the decision-making of public decision-makers.
• HAS publishes the 2022 results of the quality of care indicators in healthcare establishments, Press release, 10 Feb. 2023.
• Indicators of quality and safety of care in healthcare establishments – Campaigns, results and development of indicators, HAS, 10 February 2023.
