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| dashboard:report_2013-2024 [2025/07/02 20:15] – admin | dashboard:report_2013-2024 [2025/07/02 21:01] (versione attuale) – [Red Zone: Critical Areas (Q4 Performance)] admin | ||
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| - | ====== VON Control Charts Dashboard | + | /* This is |
| + | a multi-line | ||
| + | comment */ | ||
| - | ===== 📊 Overview Metriche Critiche | + | ====== VON Complete Dashboard 2024 - All Key Performance Measures ====== |
| - | ^ Metrica ^ Status 2023 ^ Trend ^ Priorità ^ Target ^ | + | ===== 📊 Executive Summary - Centro 297 Performance ===== |
| - | | **Any Late Infection** | 5.9% | ⬇️ **MIGLIORAMENTO** | 🟢 BASSA | <8% (VON Mediana) | | + | |
| - | | **Necrotizing Enterocolitis** | 14.7% | ⬆️ **PEGGIORAMENTO** | 🔴 ALTA | <3% (VON Mediana) | | + | |
| - | | **Mortality** | 2.9% | ⬇️ **ECCELLENTE** | 🟢 BASSA | <14% (VON Mediana) | | + | |
| - | | **Chronic Lung Disease** | 11.1% | ⬇️ **MIGLIORAMENTO** | 🟢 BASSA | <23% (VON Mediana) | | + | |
| - | | **Any Human Milk** | 61.3% | ⬆️ Miglioramento | 🟡 MEDIA | >63% (VON Mediana) | | + | |
| - | --- | + | **Data:** VON Annual Report 2024 | **N = 34 infants** (VLBW ≤1500g or ≤29w6d) |
| + | ^ Performance Level ^ Count ^ Metriche ^ Impact ^ | ||
| + | | **🟢 TOP QUARTILE (Q1)** | **8/17** | **47%** | ✅ ECCELLENZA | | ||
| + | | **🟡 ABOVE MEDIAN** | **4/17** | **24%** | ✅ BUONA | | ||
| + | | **🟠 BELOW MEDIAN** | **3/17** | **18%** | ⚠️ ATTENZIONE | | ||
| + | | **🔴 BOTTOM QUARTILE (Q4)** | **2/17** | **12%** | 🚨 CRITICA | | ||
| - | ===== 📈 Any Late Infection - Controllo Qualità ===== | + | **🎯 POSIZIONAMENTO GENERALE:** **Top Performer** VON Network (71% metriche sopra mediana) |
| - | **⚠️ METRICA AD ALTO RISCHIO | + | --- |
| + | |||
| + | /* 1. MORTALITY & MAJOR MORBIDITY | ||
| + | |||
| + | ===== 📈 Primary Outcomes - Mortality Composite ===== | ||
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| - | ^ Anno ^ Centro 297 (%) ^ VON Mediana (%) ^ Q1-Q3 VON ^ Gap vs VON ^ Status ^ | + | ==== Mortality & Morbidity Analysis ==== |
| - | | 2013 | 16.3 | 9.4 | 4.5-15.7 | **+6.9** | ❌ Sopra Q3 | | + | |
| - | | 2014 | 22.2 | 9.1 | 3.9-15.2 | **+13.1** | ❌ Molto sopra | | + | |
| - | | 2015 | 28.3 | 9.5 | 4.4-16.0 | **+18.8** | ❌ Critico | | + | |
| - | | 2016 | 31.0 | 9.0 | 4.1-15.0 | **+22.0** | ❌ **FUORI UCL** | | + | |
| - | | 2017 | 12.5 | 8.1 | 3.6-14.0 | **+4.4** | ⚠️ Sopra mediana | | + | |
| - | | 2018 | 13.9 | 7.8 | 3.2-13.3 | **+6.1** | ⚠️ Sopra Q3 | | + | |
| - | | 2019 | 15.4 | 7.5 | 2.6-13.0 | **+7.9** | ❌ Sopra Q3 | | + | |
| - | | 2020 | 18.8 | 7.7 | 2.0-13.3 | **+11.1** | ❌ Molto sopra | | + | |
| - | | 2021 | 15.4 | 7.8 | 3.0-13.5 | **+7.6** | ❌ Sopra Q3 | | + | |
| - | | 2022 | 19.4 | 8.3 | 3.4-14.3 | **+11.1** | ❌ Molto sopra | | + | |
| - | | 2024 | 5.9 | 8.2 | 1.2-14.3 | **-2.3** | ✅ **ECCELLENTE** | | + | |
| - | **📊 Statistiche | + | ^ Metrica ^ Centro 297 (%) ^ VON Median (%) ^ Quartile ^ Gap ^ Performance ^ |
| - | - **Media:** 15.1% (vs 8.5% VON) | + | | **Mortality** | 2.9 | 13.9 | 🟢 **Q1** | **-11.0** | ✅ ECCELLENTE | |
| - | - **UCL:** 30.8% | **LCL:** 6.0% | + | | **Mortality Excluding Early** | 2.9 | 9.0 | 🟢 **Q1** | **-6.1** | ✅ ECCELLENTE | |
| - | - **Trend 2024:** **BREAKTHROUGH** - Sotto mediana VON! | + | | **Death or Morbidity** | 35.3 | 41.2 | 🟡 Q1-Q2 | **-5.9** | ✅ BUONA | |
| - | - **Capability:** Processo in **rapido miglioramento** | + | | **Any Late Infection** | 5.9 | 8.2 | 🟡 Q1-Q2 | **-2.3** | ✅ BUONA | |
| + | | **Necrotizing Enterocolitis** | 14.7 | 3.4 | 🔴 **Q4** | **+11.3** | 🚨 CRITICA | | ||
| --- | --- | ||
| - | ## 2. NECROTIZING ENTEROCOLITIS | + | /*2. ORGAN-SPECIFIC MORBIDITIES |
| - | ===== 📈 Necrotizing Enterocolitis - Controllo Qualità | + | ===== 📈 Neurological, |
| - | + | ||
| - | **🚨 ALERT 2022 - Picco critico 15.6%** | + | |
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| - | ^ Anno ^ Centro 297 (%) ^ VON Mediana | + | ==== Organ-Specific Morbidity Analysis ==== |
| - | | 2013 | 2.0 | 3.8 | 0.0-7.1 | ✅ Sotto mediana | Buona performance | + | |
| - | | 2014 | 0.0 | 3.8 | 0.0-7.1 | ✅ Ottimo | Zero casi | | + | ^ Metrica |
| - | | 2015 | 4.2 | 3.3 | 0.0-6.7 | + | | **Chronic Lung Disease < |
| - | | 2016 | 3.4 | 3.3 | 0.0-6.5 | ⚠️ Sopra mediana | Stabile | | + | | **Pneumothorax** |
| - | | 2017 | 0.0 | 3.3 | 0.0-6.5 | + | | **Severe IVH** | 5.9 | 6.0 | 🟡 Q1-Q2 | 0 | ✅ BUONA | |
| - | | 2018 | 5.6 | 3.5 | 0.0-6.6 | ⚠️ Sopra mediana | Attenzione | | + | | **Cystic PVL** | 0.0 | 0.0 | 🟢 **Q1** |
| - | | 2019 | 3.7 | 3.2 | 0.0-6.9 | ⚠️ Sopra mediana | + | | **Severe ROP** | 0.0 | 2.6 | 🟢 **Q1** | 0 | ✅ ECCELLENTE |
| - | | 2020 | 0.0 | 3.2 | 0.0-6.7 | + | |
| - | | 2021 | 0.0 | 3.2 | 0.0-6.7 | ✅ Ottimo | Zero casi | | + | |
| - | | 2022 | 15.6 | 3.2 | 0.0-6.7 | ❌ **FUORI UCL** | **CRITICO** | | + | |
| - | | 2024 | 14.7 | 3.4 | 0.0-7.1 | + | |
| --- | --- | ||
| - | ## 3. MORTALITY | + | /* 3. DISCHARGE OUTCOMES & GROWTH |
| - | ===== 📈 Mortality - Controllo Qualità | + | ===== 📈 Discharge Quality & Growth Parameters |
| - | + | ||
| - | **✅ PERFORMANCE BUONA - Sotto VON mediana** | + | |
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| </ | </ | ||
| - | **✅ PERFORMANCE ECCELLENTE: | + | ==== Discharge Quality Metrics ==== |
| - | - **Media Centro:** 5.4% vs 11.4% VON (**-6.0 punti**) | + | |
| - | - **2024:** 2.9% - **Performance straordinaria**, | + | |
| - | --- | + | ^ Metrica ^ Centro 297 (%) ^ VON Median (%) ^ Quartile ^ Target ^ Performance ^ |
| + | | **Any Human Milk** | 61.3 | 63.0 | 🟡 Q1-Q2 | >50% | ✅ BUONA | | ||
| + | | **Oxygen at Discharge** | 0.0 | 4.9 | 🟢 **Q1** | 0% | ✅ ECCELLENTE | | ||
| + | | **Monitor at Discharge** | 0.0 | 4.5 | 🟢 **Q1** | 0% | ✅ ECCELLENTE | | ||
| + | | **Discharge Weight >3rd** | 71.4 | 72.7 | 🟡 Q2-Q3 | >70% | ✅ BUONA | | ||
| + | | **Head Circumference >3rd** | 96.4 | 88.1 | 🟢 **Q1** | >80% | ✅ ECCELLENTE | | ||
| + | | **Discharge Weight >10th** | 57.1 | 50.0 | 🟡 Q1-Q2 | >50% | ✅ BUONA | | ||
| + | | **Head Circumference >10th** | 85.7 | 69.6 | 🟢 **Q1** | >70% | ✅ ECCELLENTE | | ||
| - | ## 4. CHRONIC LUNG DISEASE | + | --- |
| - | ===== 📈 Chronic Lung Disease <33 Weeks - Controllo Qualità ===== | + | /* 4. LENGTH OF STAY ANALYSIS \* |
| - | **⚠️ TREND NEGATIVO | + | ===== 📊 Efficiency Metrics |
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| </ | </ | ||
| - | **✅ TURNAROUND ECCELLENTE:** | + | **📊 Length of Stay Performance:** |
| - | - **2017-2018:** Periodo eccellente | + | - **Home:** 57 days vs 70 median |
| - | - **2019-2023:** Peggioramento progressivo fino a 27.3% | + | - **Transfer:** 44 days vs 49 median (**-5 days** - MIGLIORE) |
| - | - **2024:** **RECOVERY STRAORDINARIO** - 11.1% sotto VON mediana! | + | - **Overall:** 55 days vs 59 median (**-4 days** - EFFICIENTE) |
| --- | --- | ||
| - | ## 5. DASHBOARD | + | /* 5. COMPREHENSIVE SCORECARD \* |
| + | |||
| + | ===== 🎯 Complete Performance Matrix - All 17 Measures ===== | ||
| + | |||
| + | ==== Green Zone: Excellence (Q1 Performance) ==== | ||
| + | |||
| + | ^ Metrica ^ Centro 297 ^ VON Q1 ^ Status ^ Maintained Since ^ | ||
| + | | **Mortality** | 2.9% | ≤8.3% | ✅ **TOP 25%** | 2024 breakthrough | | ||
| + | | **Mortality Excluding Early** | 2.9% | ≤4.5% | ✅ **TOP 25%** | 2024 breakthrough | | ||
| + | | **Chronic Lung Disease** | 11.1% | ≤11.1% | ✅ **TOP 25%** | 2024 recovery | | ||
| + | | **Cystic PVL** | 0.0% | ≤0.0% | ✅ **TOP 25%** | Consistently excellent | | ||
| + | | **Severe ROP** | 0.0% | ≤0.0% | ✅ **TOP 25%** | Consistently excellent | | ||
| + | | **Oxygen at Discharge** | 0.0% | ≤0.0% | ✅ **TOP 25%** | Consistently excellent | | ||
| + | | **Monitor at Discharge** | 0.0% | ≤0.0% | ✅ **TOP 25%** | Consistently excellent | | ||
| + | | **Head Circumference >3rd** | 96.4% | ≥95.0% | ✅ **TOP 25%** | Growth excellence | | ||
| + | |||
| + | ==== Yellow Zone: Above Median (Q1-Q2 Performance) ==== | ||
| + | |||
| + | ^ Metrica ^ Centro 297 ^ VON Median ^ Gap ^ Trend ^ | ||
| + | | **Death or Morbidity** | 35.3% | 41.2% | **-5.9** | ✅ Better than median | | ||
| + | | **Any Late Infection** | 5.9% | 8.2% | **-2.3** | ✅ Better than median | | ||
| + | | **Severe IVH** | 5.9% | 6.0% | **-0.1** | ✅ At median | | ||
| + | | **Any Human Milk** | 61.3% | 63.0% | **-1.7** | ⚠️ Slightly below | | ||
| + | |||
| + | ==== Orange Zone: Below Median (Q2-Q3 Performance) ==== | ||
| + | |||
| + | ^ Metrica ^ Centro 297 ^ VON Median ^ Gap ^ Action Needed ^ | ||
| + | | **Discharge Weight >3rd** | 71.4% | 72.7% | **-1.3** | 🟡 Minor concern | | ||
| + | | **Discharge Weight >10th** | 57.1% | 50.0% | **+7.1** | ✅ Actually good | | ||
| + | | **Head Circumference >10th** | 85.7% | 69.6% | **+16.1** | ✅ Actually excellent | | ||
| + | |||
| + | ==== Red Zone: Critical Areas (Q4 Performance) ==== | ||
| + | |||
| + | ^ Metrica ^ Centro 297 ^ VON Median ^ Gap ^ Priority ^ | ||
| + | | **Necrotizing Enterocolitis** | 14.7% | 3.4% | **+11.3** | 🚨 **URGENT** | | ||
| + | | **Pneumothorax** | 11.8% | 2.9% | **+8.9** | 🚨 **HIGH** | | ||
| + | |||
| + | --- | ||
| + | |||
| + | /*6. STRATEGIC | ||
| + | |||
| + | ===== 🎯 2025 Strategic Priorities ===== | ||
| + | |||
| + | ==== Priority 1: Critical Issues Resolution (Q1 2025) ==== | ||
| + | |||
| + | **🚨 NECROTIZING ENTEROCOLITIS - Immediate Action** | ||
| + | - **Current: | ||
| + | - **Target:** <7% by Q2 2025 (move to Q2-Q3) | ||
| + | - **Actions: | ||
| + | - [ ] Emergency review feeding protocols | ||
| + | - [ ] Audit antibiotic prophylaxis guidelines | ||
| + | - [ ] Staff retraining on early recognition | ||
| + | - [ ] Weekly case reviews for 6 months | ||
| + | |||
| + | **⚠️ PNEUMOTHORAX - Protocol Review** | ||
| + | - **Current: | ||
| + | - **Target:** <6% by Q3 2025 (move to Q2-Q3) | ||
| + | - **Actions: | ||
| + | - [ ] Ventilation strategy review | ||
| + | - [ ] Surfactant administration protocols | ||
| + | - [ ] Respiratory therapy training update | ||
| + | |||
| + | ==== Priority 2: Excellence Maintenance (Ongoing) ==== | ||
| + | |||
| + | **✅ MORTALITY LEADERSHIP** | ||
| + | - **Achievement: | ||
| + | - **Maintain: | ||
| + | - **Share:** Document best practices for network | ||
| + | |||
| + | **✅ CHRONIC LUNG DISEASE RECOVERY** | ||
| + | - **Achievement: | ||
| + | - **Maintain: | ||
| + | - **Monitor: | ||
| + | |||
| + | **✅ DISCHARGE QUALITY** | ||
| + | - **Achievement: | ||
| + | - **Optimize: | ||
| + | - **Maintain: | ||
| - | ===== 🎯 KPI Summary e Azioni Prioritarie ===== | + | ==== Priority 3: Continuous Improvement (2025-2026) |
| - | ==== Status Generale Centro 297 (2024) ==== | + | **📈 HUMAN MILK OPTIMIZATION** |
| + | - **Current: | ||
| + | - **Target:** >70% by end 2025 | ||
| + | - **Strategy: | ||
| - | ^ Metrica ^ Performance ^ vs VON ^ Trend ^ Azione Richiesta ^ | + | **📊 BENCHMARKING LEADERSHIP** |
| - | | **Mortality** | ✅ **ECCELLENTE** | -11.0 punti | ⬇️ Miglioramento | Mantenere standard | | + | - **Goal:** Achieve Q1 performance in >80% metrics |
| - | | **Any Human Milk** | ✅ **BUONA** | -1.7 punti | ⬆️ | + | - **Current:** 47% Q1 performance |
| - | | **Any Late Infection** | ✅ **ECCELLENTE** | -2.3 punti | ⬇️ | + | - **Timeline:** 18-month improvement plan |
| - | | **Chronic Lung Disease** | ✅ **ECCELLENTE** | -12.0 punti | ⬇️ **Recovery** | Mantenere protocolli | | + | |
| - | | **Necrotizing Enterocolitis** | ❌ **CRITICA** | +11.3 punti | ⬆️ **Peggioramento** | **URGENTE** | | + | |
| - | ==== Top 3 Priorità 2025 ==== | + | ==== Investment & ROI ==== |
| - | **🚨 1. NECROTIZING ENTEROCOLITIS (Priorità Massima)** | + | ^ Priority ^ Investment ^ Timeline ^ Expected ROI ^ |
| - | - **Alert critico:** 14.7% vs 3.4% VON (+11.3 punti) | + | | **NEC Resolution** | €15,000 | 6 months | Move from Q4 to Q2 | |
| - | - **Trend:** Peggioramento dopo anni di miglioramento | + | | **Pneumothorax Protocol** | €8,000 | 9 months | Move from Q4 to Q2 | |
| - | - **Azione:** Review urgente protocolli nutrizione + audit | + | | **Excellence Maintenance** | €5,000 | Ongoing | Maintain Q1 status | |
| + | | **Human Milk Optimization** | €3,000 | 12 months | Reach Q1 performance | | ||
| + | | **TOTAL** | **€31, | ||
| - | **✅ 2. CONSOLIDAMENTO SUCCESSI (Mantenimento)** | + | ==== Success Metrics 2025 ==== |
| - | - **Late Infection: | + | |
| - | - **Chronic Lung Disease:** Recovery 11.1% vs 23.1% | + | |
| - | - **Azione:** Standardizzare best practices + training | + | |
| - | **📈 3. ANY HUMAN MILK (Completamento Recovery)** | + | **Q2 2025 Targets:** |
| - | - **Progresso:** Da 52.0% (2023) a 61.3% (2024) | + | - ✅ NEC: <7% (from 14.7%) |
| - | - **Gap residuo:** -1.7 punti vs VON (molto ridotto) | + | - ✅ Pneumothorax: <6% (from 11.8%) |
| - | - **Azione:** Finalizzare protocolli + raggiungere | + | - ✅ Maintain all current Q1 metrics |
| + | - ✅ Human Milk: >65% | ||
| - | ==== Piano di Azione Coordinato ==== | + | **Year-End 2025 Goal:** |
| + | - 🎯 **>75% metrics in Q1-Q2** (vs current 71%) | ||
| + | - 🎯 **Zero Q4 metrics** (vs current 2) | ||
| + | - 🎯 **VON Network Top 10%** overall ranking | ||
| - | **Immediate (0-3 mesi):** | + | ===== 📊 Quick Reference Performance Card ===== |
| - | - [ ] **NEC Protocol Emergency Review** - Nutrizione + antibiotici | + | |
| - | - [ ] **Success Factor Analysis** - CLD e Late Infection protocols | + | |
| - | - [ ] **Human Milk Program** - Finalizzare recovery a 65% | + | |
| - | **Medio termine | + | **🟢 EXCELLENT |
| - | - [ ] **Staff Training** consolidamento protocolli vincenti | + | **🟡 GOOD (7 metrics):** Morbidity, Infection, IVH, Human Milk, Weights |
| - | - [ ] **Quality Dashboard** real-time per monitoring | + | **🔴 CRITICAL (2 metrics):** NEC, Pneumothorax |
| - | - [ ] **Benchmark Maintenance** per metriche eccellenti | + | |
| - | **Budget stimato:** €25,000 per consolidamento (vs €45,000 precedente) | + | **Overall Grade: B+ (Excellent with 2 critical areas)** |
| - | **ROI atteso:** Mantenimento top quartile + risoluzione NEC | + | **Network Ranking: Estimated Top 25%** |
| + | **2025 Goal: A- (Top 10% with all areas resolved)** | ||