1. Statistical Process Control Tim Wiemken, PhD MPH CIC Assistant Professor, University of Louisville School of Medicine, Division of Infectious Diseases Director, University of Louisville Hospital Epidemiology Program Assistant Director of Epidemiology and Biostatistics, Clinical and Translational Research Support Center Louisville, KY tim.wiemken@louisville.edu

2. Overview Appropriate use of charts Run Charts Statistical Process Control Charts Examples…

3. Appropriate Use of Charts 1.Pie is to eat, not to display your data.

4. Appropriate Use of Charts 1.Pie is to eat, not to display your data. “Use a pie chart when you don’t have anything to say” - Dr. Julio Ramirez “Use a pie chart when you don’t have anything to say” - Dr. Julio Ramirez

5. Appropriate Use of Charts 2.Bars are for buying booze, not for displaying consecutive data points. Don’t do this

6. Appropriate Use of Charts 2.Bars are for drinking, not for displaying consecutive data points. Or this

7. Appropriate Use of Charts 3.Line charts are good. They display consecutive data points. That’s all. Do this

8. Overview Appropriate use of charts Run Charts Statistical Process Control Charts Examples…

9. Run Charts Line chart when you have few time periods (e.g. <25 months).

10. Run Charts Anatomy Center Line / Median –represents the median of all of the data points. X-axis –represents the time period of interest (days, weeks, months, quarters, years). Y-axis –represents the scale of the plotted data points (e.g. rate or count of infection). Data points – the actual data values.

11. Y-axis (Rate) X-axis (Month) Center Line (Median) Data Points (<25) Run Charts

12. Use to identify when the data are different than you expect (for better or worse) through detecting abnormal variation Run Charts

13. Rules for abnormal variation 1.Seven or more consecutive points on either side of the Center Line (median). 2.Five or more consecutive points increasing or decreasing. 3.Fourteen or more consecutive points alternating up and down. Run Charts

14. Rule 1 7 points below median Rule 2 5 consecutive points increasing Run Charts

15. Overview Appropriate use of charts Run Charts Statistical Process Control Charts Examples…

16. Use when you have many time periods (e.g. ≥25 months). –These are much better than run charts. Statistical Process Control Charts

17. Use when you have many time periods (e.g. ≥25 months). –These are much better than run charts. But not more than 50 points Statistical Process Control Charts

18. They help identify the difference between Statistical Process Control Charts 1.Common cause variation (in-control) 2.Special cause variation (out of control)

19. Anatomy Center Line / Mean–represents the average of all of the data points. X-axis –represents the time period of interest (days, weeks, months, quarters, years). Y-axis –represents the scale of the plotted data points (e.g. rate or count of infection). Data points – the actual data values. Standard deviation lines (control limits) – represent 1, 2 or 3 standard deviations on each side of the center line Statistical Process Control Charts

20. What’s up with the standard deviation? Statistical Process Control Charts

21. What’s up with the standard deviation? All data have a distribution. Statistical Process Control Charts

22. What’s up with the standard deviation? All data have a distribution. This distribution can be broken up into standard deviations – measures of variation from the average Statistical Process Control Charts

24. 1.68% of data fall in 1 standard deviation of the average 2.95% of the data will fall within 2 standard deviations 3.99% will fall within 3 standard deviations Statistical Process Control Charts

25. 1.68% of data fall in 1 standard deviation of the average 2.95% of the data will fall within 2 standard deviations 3.99% will fall within 3 standard deviations One point outside of 3 standard deviations would be abnormal Statistical Process Control Charts

27. 99% of Data Should Be In Here!

28. one point above or below 3SD two of three points above/below 2SD four of five points above/below 1SD eight points in a row on either side of the mean trends of 6 points in a row increasing or decreasing fourteen points in a row alternating up and down eight points in a row outside of 1SD Statistical Process Control Charts

29. There are many different types of charts Using the wrong chart will give you the wrong results You may miss an outbreak You may institute interventions that are not necessary (e.g. waste your time!) Statistical Process Control Charts

30. P Chart Use for: 1. Microbiological surveillance rates 2. Compliance rates U Chart Use for: 1. Device-associated infections Statistical Process Control Charts

31. Put all of your data into a nice clean report! Not all reports are appropriate for all audiences. Remember it is about the audience’s interests, not yours! Statistical Process Control Charts

32. Example introductory slide for MRSA rates Hospital-associated Methicillin- resistant Staphylococcus aureus (MRSA) Case of MRSA (Numerator): A case of MRSA was defined as a new and unique, hospital-associated (isolated >48 hours after admission), microbiological isolate from a patient admitted to hospital x during the month of interest without a prior history of MRSA. Patient days (Denominator): The denominator for the calculation of the rate of MRSA was defined as the number of patient-days for hospital x during the month of interest, regardless of risk status. Rate: (Numerator / Denominator) * 1,000

33. Hospital-Associated Methicillin-resistant Staphylococcus aureus Isolates: Hospital X, MICU, January 2006 – January 2010 # HA MRSA Isolates divided by # Bed-days of Care Assessment: Process is in statistical control. Plan: Continue surveillance activities.

34. Statistical Process Control Charts

35. Examples Statistical Tools Workbook

36. you must use clinical judgement in addition to statistics Conclusion