A synergistic effect exists between employee engagement and decreased levels of workers' compensation claims for improving patient safety culture. Organizations can improve engagement and implement safety policies, procedures, and devices for employees with an ultimate effect of improving patient safety culture.

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INTRODUCTION AND OBJECTIVE: Kidney and ureter (Upper Urinary Tract -UUT) stone prevalence is rising in Europe. The resultant increase in demand on services may be challenging for hospitals to manage, increasing the burden on patients and healthcare providers (HCPs). In this analysis we investigate the evolution of UUT diagnoses and surgical procedures to treat UUT stones in Germany (DE), France (FR), and England (EN) over the past decade.METHODS: We identified International Classification of Diseases (ICD-10) codes related to UUT stones diagnosis and extracted procedure volumes for Extracorporeal Shock Wave Lithotripsy (ESWL), Ureteroscopy (URS), Percutaneous Nephrolithotomy (PCNL) and open prostatectomy (OP) using national procedure codes from the German G-DRG system, the French Technical Agency of Hospitalization Information and NHS England Hospital Episode Statistics. We analyzed the procedure volumes compared to the volume of hospital UUT stone diagnoses from 2010 to 2019.RESULTS: Between 2010-2019, the ICD-10 N20 codes for calculus of kidney and ureter increased by 8%; 26% and 15% in DE, FR, EN respectively, whereas stone procedures increased by 3%; 38% and 18%. In 2010, the dominant procedure to treat UUT stones was ESWL (49%; 53% 60%; for DE, FR and EN respectively). In 2019, URS was the dominant procedure (75%; 74%; 51%; in DE; FR and EN respectively). PCNL and OP represent only a small percentage of UUT stones procedures: <12% in DE and <5% in FR and EN.CONCLUSIONS: This analysis highlights an increase in UUT stones diagnoses and surgical procedures in DE, FR, EN over the last 10 years. There were 20-30% more reported diagnoses per 100,000 population in FR than in DE and EN. The gap between the diagnoses volume and the treatments volume was around 15% in DE, 20% in FR and 45% in EN.The surgical management of UUT stone has shifted from ESWL towards URS. The trend may be due to clinical advantages such as lower recurrence rate after URS and advances in technology, but other factors such as physician preference and costs may play a role. The continued rise of UUT stone prevalence has implications for patients, hospitals and HCPs. Solutions to optimize the service delivery and workforce planning, as well reducing length of stay could help to address this situation.

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frequently (23% vs 22%, p <0.01) and dealt with more complex patients evidenced by higher Hierarchical Condition Category (HCC) risk adjustment scores (1.50 vs 1.40, p <0.01). Number of Medicare beneficiaries did not significantly differ between OCM and non-OCM urologists (504 vs 518, p[0.50). However, OCM urologists received higher median Medicare payments per beneficiary ($314vs $281, p <0.01) and per service ($60 vs $50, p <0.01). OCM urologists provided fewer services than non-OCM urologists (2534 vs 3101, p[0.06) (Table 1).CONCLUSIONS: Only small number of urologists are participating in the OCM. New York had above average participation of urologists in OCM. OCM urologists were more likely to provide care to patients with the diagnosis of cancer and higher HCC scores. They received higher payment per services provided and beneficiaries seen.