Evaluation of an electronic health record structured discharge summary to provide real time adverse event reporting in thoracic surgery
| Autor: | Danielle A. Southern, Kevin Lonergan, Biraboneye Vito, Sean McFadden, Anthony Falvi, William A. Ghali, Andrew J. Graham, Bruce Wang, Dina Sotiropoulos, Wrechelle Ocampo |
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| Rok vydání: | 2019 |
| Předmět: |
Safety Management
medicine.medical_specialty Quality Assurance Health Care Documentation Audit 03 medical and health sciences Patient safety 0302 clinical medicine Electronic health record Outcome Assessment Health Care medicine Electronic Health Records Humans 030212 general & internal medicine Adverse effect Discharge summary Data collection Medical Errors business.industry 030503 health policy & services Health Policy Thoracic Surgical Procedures Quality Improvement Cardiothoracic surgery Emergency medicine Patient Safety 0305 other medical science business Kappa |
| Zdroj: | BMJ Quality & Safety. 28:310-316 |
| ISSN: | 2044-5423 2044-5415 |
| DOI: | 10.1136/bmjqs-2018-008090 |
| Popis: | BackgroundThe reporting of adverse events (AE) remains an important part of quality improvement in thoracic surgery. The best methodology for AE reporting in surgery is unclear. An AE reporting system using an electronic discharge summary with embedded data collection fields, specifying surgical procedure and complications, was developed. The data are automatically transferred daily to a web-based reporting system.MethodsWe determined the accuracy and sustainability of this electronic real time data collection system (ERD) by comparing the completeness of record capture on procedures and complications with coded discharge data (administrative data), and with the standard of chart audit at two intervals. All surgical procedures performed for 2 consecutive months at initiation (Ti) and 1 year later (T1yr) were audited by an objective trained abstractor. A second abstractor audited 10% of the charts.ResultsThe ERD captured 71/72 (99%) of charts at Ti and 56/65 (86%) at T1yr. Comparing the presence/absence of complications between ERD and chart audit demonstrated at Ti a high sensitivity and specificity, positive predictive value (PPV) of 95.5%, negative predictive value (NPV) of 93.9% with a kappa of 0.872 (95% CI 0.750 to 0.994), and at T1yr a sensitivity, specificity, PPV and NPV of 100% with a kappa of 1.0 (95% CI 1.0). Comparing the presence/absence of complications between administrative data and chart audit at Ti demonstrated a low sensitivity, high specificity and a kappa of 0.471 (95% CI 0.256 to 0.686), and at T1yr a low sensitivity, high specificity of 85% and a kappa of 0.479 (95% CI 0.245 to 0.714).ConclusionsWe found that the ERD can provide accurate real time AE reporting in thoracic surgery, has advantages over previous reporting methodologies and is an alternative system for surgical clinical teams developing AE reporting systems. |
| Databáze: | OpenAIRE |
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