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Allaudeen N, Schalch E, Neff M, Poppler K, Vashi AA. Patient Safety Indicators at an Academic Veterans Affairs Hospital: Addressing Dual Goals of Clinical Care and Validity. Jt Comm J Qual Patient Saf 2024; 50:638-644. [PMID: 38821745 DOI: 10.1016/j.jcjq.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Hospital-acquired complications add to patient morbidity and mortality, costs, length of stay, and negative patient experience. Patient Safety Indicators (PSIs) are a validated and widely used metric to evaluate hospital administrative data on preventing these events. Although many studies have addressed PSI validity, few have aimed to reduce PSI through clinical care. The authors aimed to reduce PSI events by addressing both validity and clinical care. METHODS Frontline clinicians used a deep dive template to provide input on all PSI cases, which were then reviewed by a PSI task force to identify performance gaps. After analyzing the frequency of gaps and cost-vs.-impact of potential solutions, five interventions were implemented to address the three most common, highly weighted PSIs: pressure ulcers, postoperative venous thromboembolism (VTE), and postoperative sepsis. Clinical care interventions included increasing patient mobility by creating a specialized mobility technician position, skin care audits to prevent pressure ulcers, and increasing use of pharmacologic VTE prophylaxis. Administrative interventions addressed improving clinician-coding concordance for sepsis and increasing documentation of comorbidities. RESULTS After interventions, the number of PSI events for composite PSI, VTE, and sepsis decreased by 41.3% (p = 0.039), 85.2% (p = 0.0091), and 51.5% (p = 0.063), respectively, relative to the preintervention period. Pressure ulcers increased by 33.3% (p = 0.0091). CONCLUSION Hospital complications cause substantial burden to hospitals, patients, and caregivers. Addressing administrative and clinical factors with targeted interventions led to reduction in composite PSI. Further efforts are needed locally to reduce the pressure ulcer PSI.
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Giese A, Khanam R, Nghiem S, Staines A, Rosemann T, Boes S, Havranek MM. Assessing the excess costs of the in-hospital adverse events covered by the AHRQ's Patient Safety Indicators in Switzerland. PLoS One 2024; 19:e0285285. [PMID: 38315675 PMCID: PMC10843032 DOI: 10.1371/journal.pone.0285285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/19/2023] [Indexed: 02/07/2024] Open
Abstract
There currently exists no comprehensive and up-to date overview on the financial impact of the different adverse events covered by the Patient Safety Indicators (PSIs) from the Agency for Healthcare Research and Quality. We conducted a retrospective case-control study using propensity score matching on a national administrative data set of 1 million inpatients in Switzerland to compare excess costs associated with 16 different adverse events both individually and on a nationally aggregated level. After matching 8,986 cases with adverse events across the investigated PSIs to 26,931 controls, we used regression analyses to determine the excess costs associated with the adverse events and to control for other cost-related influences. The average excess costs associated with the PSI-related adverse events ranged from CHF 1,211 (PSI 18, obstetric trauma with instrument) to CHF 137,967 (PSI 10, postoperative acute kidney injuries) with an average of CHF 27,409 across all PSIs. In addition, adverse events were associated with 7.8-day longer stays, 2.5 times more early readmissions (within 18 days), and 4.1 times higher mortality rates on average. At a national level, the PSIs were associated with CHF 347 million higher inpatient costs in 2019, which corresponds to about 2.2% of the annual inpatient costs in Switzerland. By comparing the excess costs of different PSIs on a nationally aggregated level, we offer a financial perspective on the implications of in-hospital adverse events and provide recommendations for policymakers regarding specific investments in patient safety to reduce costs and suffering.
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Affiliation(s)
- Alice Giese
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Rasheda Khanam
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Son Nghiem
- College of Health & Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anthony Staines
- IFROSS Institute, University of Lyon III, Lyon, France
- Hospital Federation of Vaud, Prilly, Vaud, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Stefan Boes
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Michael M. Havranek
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Moon J, AlFarsi M, Marinescu D, AlQahtani M, Pang A, Ghitulescu G, Vasilevsky CA, Boutros M. Emergency colectomies in the NOAC era: a nationwide analysis demonstrating increased complications. Surg Endosc 2023; 37:660-668. [PMID: 36163564 DOI: 10.1007/s00464-022-09630-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/11/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The use of Non-vitamin K antagonist oral anticoagulants (NOAC) has increased substantially since their introduction in 2010. The lack of readily available reversal agents poses a challenge in perioperative management. The aim of this study was to evaluate the impact of NOACs on the outcomes of emergency colectomies. METHODS All adult patients on long-term anticoagulation who underwent emergency colectomies were identified from the Nationwide Inpatient Sample (NIS) database from 2002 to 2018. Long-term anticoagulation was defined using ICD-9/10 codes. Two cohorts were compared: anticoagulated patients in the pre-NOAC era (2002-2010) and anticoagulated patients in the NOAC era (2010-2018). Outcomes of interest were postoperative surgical complications, mortality and need for transfusion. RESULTS Of 13,218 patients on long-term anticoagulation, 3,264 patients were treated in the pre-NOAC era and 9,954 in the NOAC era. Over the study period, there was a significant increase in the proportion of anticoagulated patients undergoing emergency colectomies (R2 = 0.91). On univariate analysis, anticoagulated patients in the NOAC era were medically more comorbid and had higher rates of postoperative surgical complications (73.3% vs 60.3%, p < 0.001) and mortality (8.2% vs. 6.7%, p = 0.006), but had lower rates of postoperative bleeding (3.5% vs. 4.4%, p = 0.002) and transfusions (38.1% vs. 45.4%, p < 0.001). On multivariable regression, after accounting for clinically significant covariates, anticoagulation in the NOAC era was associated with decreased rates of postoperative bleeding (OR 0.70, 95%CI 0.57-0.88) and transfusions (OR 0.71 95%CI 0.64-0.77) but remained an independent predictor of increased overall postoperative complications (OR 1.26, 95%CI 1.14-1.39). CONCLUSION Prevalence of long-term anticoagulation in patients undergoing emergency colectomies is increasing. Although associated with lower rates of postoperative bleeding and transfusions, anticoagulation in the NOAC era is associated with higher rates of overall postoperative complications. Evidence-based guidelines for perioperative management of patients on NOACs in the emergency colorectal surgery setting are needed.
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Affiliation(s)
- Jeongyoon Moon
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Maryam AlFarsi
- Department of Surgery, McGill University, Montreal, QC, Canada
| | | | | | - Allison Pang
- Department of Surgery, McGill University, Montreal, QC, Canada
| | | | | | - Marylise Boutros
- Department of Surgery, McGill University, Montreal, QC, Canada.
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC, H3T 1E2, Canada.
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Moon J, Pang A, Ghitulescu G, Faria J, Morin N, Vasilevsky CA, Boutros M. Early discharge after colorectal cancer resection: trends and impact on patient outcomes. Surg Endosc 2022; 36:6617-6628. [PMID: 34988738 DOI: 10.1007/s00464-021-08923-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/20/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Implementation of early discharge in colorectal surgery has been effective in improving patient satisfaction and reducing healthcare costs. Readmission rates following early discharge among colorectal cancer patients are believed to be low, however, remain understudied. The objectives of this study were: (i) to describe trends in early post-operative discharge and the associated hospitalization costs; (ii) to explore patient outcomes and resource utilization following early discharge; and (ii) to identify predictors of readmission following early discharge. METHODS This was a retrospective cohort study using the Nationwide Readmissions Database. Adult patients admitted with a primary colorectal neoplasm who underwent colectomy or proctectomy between 2010 and 2017 were identified using ICD-9/10 codes. The exposure of interest was early post-operative discharge defined as ≤ 3 days from surgery. Main outcome measures were 30-day readmissions, post-operative complication rates, LOS and cost. RESULTS In total, 342,242 patients were identified, and of those, 51,977 patients (15.2%) had early discharges. During the study period, the proportion of early discharges significantly increased (R2 = 0.94), from 9.9 to 23.4%, while readmission rates in this group remained unchanged (mean 7.3% ± 0.5). Complications that required bounceback readmission (within 7 days) after early discharge, rather than during index admission, were an independent predictor of longer overall LOS (ß = 0.044, p < 0.001) and higher hospitalization costs (ß = 0.031, p < 0.001). On multiple logistic regression, factors independently associated with bounceback readmission following early discharge were: male gender (OR = 1.47, 95%CI 1.33-1.63); open surgery (OR = 1.37, 95%CI 1.23-1.52); presence of stoma (OR = 1.51, 95%CI 1.22-1.87); transfer to facility or discharge with home health service (OR = 1.53, 95%CI 1.34-1.75); and Medicare/Medicaid insurance (OR = 1.34, 95%CI 1.14-1.57), among others. CONCLUSION Early post-operative discharge of colorectal cancer patients is increasing despite a lack of improvement in readmission rates and an overall increase in hospitalization costs. Premature discharge of select patients may result in readmissions due to critical complications related to surgery resulting in increased resource utilization.
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Affiliation(s)
- Jeongyoon Moon
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Allison Pang
- Department of Surgery, McGill University, Montreal, QC, Canada
| | | | - Julio Faria
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Nancy Morin
- Department of Surgery, McGill University, Montreal, QC, Canada
| | | | - Marylise Boutros
- Department of Surgery, McGill University, Montreal, QC, Canada.
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada.
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Zabinski Z, Black BS. The deterrent effect of tort law: Evidence from medical malpractice reform. JOURNAL OF HEALTH ECONOMICS 2022; 84:102638. [PMID: 35691073 DOI: 10.1016/j.jhealeco.2022.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/26/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
We examine whether caps on noneconomic damages in medical malpractice cases affect in-hospital patient safety. We use Patient Safety Indicators - measures of adverse events - as proxies for safety. In difference-in-differences ("DiD") analyses of five states that adopt caps during 2003-2005, we find that multiple measures of non-fatal patient safety events worsen after cap adoption relative to control states. DiD inference can be unreliable with a small number of treated units. We therefore develop a randomization inference-based test for inference with few treated units but multiple correlated outcomes and confirm the robustness of our results with this nonparametric approach. We also provide evidence that the decline in patient safety is unlikely to be driven by patient selection.
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Affiliation(s)
| | - Bernard S Black
- Northwestern University, Pritzker School of Law and Kellogg School of Management
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Stocking JC, Drake C, Aldrich JM, Ong MK, Amin A, Marmor RA, Godat L, Cannesson M, Gropper MA, Romano PS, Sandrock C, Bime C, Abraham I, Utter GH. Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC 3RC). BMC Anesthesiol 2022; 22:146. [PMID: 35568812 PMCID: PMC9107656 DOI: 10.1186/s12871-022-01681-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Few interventions are known to reduce the incidence of respiratory failure that occurs following elective surgery (postoperative respiratory failure; PRF). We previously reported risk factors associated with PRF that occurs within the first 5 days after elective surgery (early PRF; E-PRF); however, PRF that occurs six or more days after elective surgery (late PRF; L-PRF) likely represents a different entity. We hypothesized that L-PRF would be associated with worse outcomes and different risk factors than E-PRF. METHODS This was a retrospective matched case-control study of 59,073 consecutive adult patients admitted for elective non-cardiac and non-pulmonary surgical procedures at one of five University of California academic medical centers between October 2012 and September 2015. We identified patients with L-PRF, confirmed by surgeon and intensivist subject matter expert review, and matched them 1:1 to patients who did not develop PRF (No-PRF) based on hospital, age, and surgical procedure. We then analyzed risk factors and outcomes associated with L-PRF compared to E-PRF and No-PRF. RESULTS Among 95 patients with L-PRF, 50.5% were female, 71.6% white, 27.4% Hispanic, and 53.7% Medicare recipients; the median age was 63 years (IQR 56, 70). Compared to 95 matched patients with No-PRF and 319 patients who developed E-PRF, L-PRF was associated with higher morbidity and mortality, longer hospital and intensive care unit length of stay, and increased costs. Compared to No-PRF, factors associated with L-PRF included: preexisiting neurologic disease (OR 4.36, 95% CI 1.81-10.46), anesthesia duration per hour (OR 1.22, 95% CI 1.04-1.44), and maximum intraoperative peak inspiratory pressure per cm H20 (OR 1.14, 95% CI 1.06-1.22). CONCLUSIONS We identified that pre-existing neurologic disease, longer duration of anesthesia, and greater maximum intraoperative peak inspiratory pressures were associated with respiratory failure that developed six or more days after elective surgery in adult patients (L-PRF). Interventions targeting these factors may be worthy of future evaluation.
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Affiliation(s)
- Jacqueline C Stocking
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Davis, 4150 V Street, Suite 3400, Sacramento, CA, 95817, USA.
| | - Christiana Drake
- Department of Statistics, University of California Davis, Davis, CA, USA
| | - J Matthew Aldrich
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Michael K Ong
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alpesh Amin
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Rebecca A Marmor
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Laura Godat
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael A Gropper
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Patrick S Romano
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Davis, 4150 V Street, Suite 3400, Sacramento, CA, 95817, USA
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA, USA
| | - Christian Sandrock
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Davis, 4150 V Street, Suite 3400, Sacramento, CA, 95817, USA
| | - Christian Bime
- College of Medicine, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Garth H Utter
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA, USA
- Department of Surgery, Outcomes Research Group, University of California Davis, Sacramento, CA, USA
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Opioid Use Disorder is Associated With Complications and Increased Length of Stay After Major Abdominal Surgery. Ann Surg 2021; 274:992-1000. [PMID: 31800489 DOI: 10.1097/sla.0000000000003697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the impact of opioid use disorder (OUD) on perioperative outcomes after major upper abdominal surgeries. SUMMARY OF BACKGROUND DATA OUD, defined as dependence/abuse, is a national health epidemic. Its impact on outcomes after major abdominal surgery has not been well characterized. METHODS Patients who underwent elective esophagectomy, total/partial gastrectomy, major hepatectomy, and pancreatectomy were identified using the National Inpatient Sample (2003-2015). Propensity score matching by baseline characteristics was performed for patients with and without OUD. Outcomes measured were in-hospital complications, mortality, length of stay (LOS), and discharge disposition. RESULTS Of 376,467 patients, 1096 (0.3%) had OUD. Patients with OUD were younger (mean 53 vs 61 years, P < 0.001) and more often male (55.1% vs 53.2%, P < 0.001), black (15.0% vs 7.6%, P < 0.001), Medicaid beneficiaries (22.0% vs 6.4%, P < 0.001), and in the lowest income quartile (32.6% vs 21.3%, P < 0.001). They also had a higher rate of alcohol (17.2% vs 2.8%, P < 0.001) and nonopioid drug (2.2% vs 0.2%, P = 0.023) dependence/abuse. After matching (N = 1077 OUD, N = 2164 no OUD), OUD was associated with a higher complication rate (52.9% vs 37.3%, P < 0.001), including increased pain [odds ratio (OR) 3.5, P < 0.001], delirium (OR 3.0, P = 0.004), and pulmonary complications (OR 2.0, P = 0.006). Additionally, OUD was associated with increased LOS (mean 12.4 vs 10.6 days, P = 0.015) and nonroutine discharge (OR 1.6, P < 0.001). In-hospital mortality did not differ (OR 2.4, P = 0.10). CONCLUSION Patients with OUD more frequently experienced complications and increased LOS. Close postoperative monitoring may mitigate adverse outcomes.
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Al-Tehewy MM, Abd Al-Razak SE, Hikal TS, Wahdan MM. Association of patient safety indicator 03 and clinical outcome in a surgery hospital. Int J Health Care Qual Assur 2021; ahead-of-print. [PMID: 33098399 DOI: 10.1108/ijhcqa-02-2020-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Patient safety indicators (PSIs) were developed as a tool for hospitals to identify potentially preventable complications and improve patient safety performance. The study aimed at measuring the incidence of the Agency for Healthcare Research and Quality (AHRQ) PSI03 (pressure ulcer [PU] rate) and to identify the association between PSI03 and clinical outcomes including death, readmission within 30 days and length of stay (LOS) at the cardiothoracic surgery hospital at Ain Shams University, Cairo, Egypt. DESIGN/METHODOLOGY/APPROACH An exploratory prospective cohort study was conducted to follow up patients, who fulfilled the inclusion criteria, from admission until one month after discharge at the cardiothoracic surgery hospital. Data were collected through basic information and follow-up sheets. The total number of included participants in the study was 330. FINDINGS PSI03 incidence rate was 67.7 per 1,000 discharges. Patients aged 60 years and above had the highest risk among all age groups. In patients who developed PSI03, the risk ratio (RR) of death was 8.8 [95% CI (3.79-20.24)], RR of staying more than 30 days at the hospital was 1.5 [95% CI (1.249-1.872)] and of readmission within 30 days in patients who developed PSI03 was 1.5 [95% CI (0.38-6.15)]. In the study's hospital, the patients who developed PSI03 were at higher risk of death and stayed longer at the hospital than patients without PSI03. This study demonstrated a clear association between PSI03 and patient outcomes such as LOS and mortality. Early detection, prevention and proper management of PSI03 are recommended to decrease unfavorable clinical outcomes. ORIGINALITY/VALUE The importance of PSIs lies in the fact that they facilitate the recognition of the adverse events and complications which occurred during hospitalization and give the hospitals a chance to improve the possible clinical outcomes. Therefore, the current study aimed at measuring the association between AHRQ PSI03 ( PU rate) and the clinical outcomes including death, readmission within 30 days and the LOS at the cardiothoracic surgery hospital at Ain Shams University. This study will provide the hospital management with baseline data for this type of adverse event and guide them to develop a system for identifying the high-risk group of patients and to upgrade relevant hospital policies and guidelines that lead to improved patient outcomes.
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Affiliation(s)
- Mahi Mahmoud Al-Tehewy
- Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sara Ebraheem Abd Al-Razak
- Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Shahat Hikal
- Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maha Magdy Wahdan
- Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Yang CC, Chuang YF, Chen PE, Tao P, Tung TH, Chien CW. Effect of Postoperative Adverse Events on Hospitalization Expenditures and Length of Stay Among Surgery Patients in Taiwan: A Nationwide Population-Based Case-Control Study. Front Med (Lausanne) 2021; 8:599843. [PMID: 33644091 PMCID: PMC7902791 DOI: 10.3389/fmed.2021.599843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The current study sought to determine the incidence of postoperative adverse events (AEs) based on data from the 2006 Taiwan National Health Insurance Research Database (NHIRD). Methods: This retrospective case-control study included patients who experienced postoperative AEs in 387 hospitals throughout Taiwan in 2006. The independent variable was the presence or absence of 10 possible postoperative AEs, as identified by patient safety indicators (PSIs). Results: A total of 17,517 postoperative AEs were identified during the study year. PSI incidence ranged from 0.1/1,000 admissions (obstetric trauma-cesarean section) to 132.6/1,000 admissions (obstetric trauma with instrument). Length of stay (LOS) associated with postoperative AEs ranged from 0.10 days (obstetric trauma with instrument) to 14.06 days (postoperative respiratory failure). Total hospitalization expenditures (THEs) ranged from 363.7 New Taiwan Dollars (obstetric trauma without instrument) to 263,732 NTD (postoperative respiratory failure). Compared to patients without AEs, we determined that the THEs were 2.13 times in cases of postoperative AE and LOS was 1.72 times higher. Conclusions: AEs that occur during hospitalization have a major impact on THEs and LOS.
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Affiliation(s)
- Chih-Chieh Yang
- Department of Business Administration, Ming Chuan University, Taipei, Taiwan.,Department of Critical Care Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Yi-Fei Chuang
- Department of Business Administration, Ming Chuan University, Taipei, Taiwan
| | - Pei-En Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.,Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | - Ping Tao
- Division of Medical Fees, Department of Medical Affairs, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan
| | - Tao-Hsin Tung
- Enze Medical Research Center, Affiliated Taizhou Hospital of Wenzhou Medical College, Taizhou, China.,Department of Medical Research and Education, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
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Brajcich BC, Fischer CP, Ko CY. Administrative and Registry Databases for Patient Safety Tracking and Quality Improvement. Surg Clin North Am 2021; 101:121-134. [DOI: 10.1016/j.suc.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ramanathan R, Leavell P, Wolfe LG, Duane TM. Agency for Healthcare Research and Quality Patient Safety Indicators and Mortality in Surgical Patients. Am Surg 2020. [DOI: 10.1177/000313481408000832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient safety indicators (PSI), developed by the Agency for Healthcare Research and Quality, use administrative billing data to measure and compare patient safety events at medical centers. We retrospectively examined whether PSIs accurately reflect patients’ risk of mortality, hospital length of stay, and intensive care unit (ICU) requirements at an academic medical center. Surgical patient records with PSIs were reviewed between October 2011 and September 2012 at our urban academic medical center. Primary outcomes studied included mortality, hospital length of stay, and ICU requirements. Subset analysis was performed for each PSI and its association with the outcome measures. PSIs were more common among surgical patients who died as compared with those alive at discharge (35.3 vs 2.7 PSIs/100 patients, P < 0.01). Although patients who died with PSIs had shorter hospital courses, they had a significantly greater ICU requirement than those without a PSI (96.0 vs 61.1%, P < 0.01) and patients who were alive at discharge (96.0 vs 48.0%, P < 0.01). The most frequently associated PSIs with mortality were postoperative metabolic derangements (41.7%), postoperative sepsis (38.5%), and pressure ulcers (33.3%). PSIs occur at a higher frequency in surgical patients who die and are associated with increased ICU requirements.
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Affiliation(s)
- Rajesh Ramanathan
- Department of Surgery, Critical Care & Emergency Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Patricia Leavell
- Performance Improvement, Critical Care & Emergency Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Luke G. Wolfe
- Department of Surgery, Critical Care & Emergency Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Therese M. Duane
- Division of Trauma, Critical Care & Emergency Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Song Y, Shannon AB, Roses RE, Fraker DL, Kelz RR, Karakousis GC. National trends in ventral hernia repairs for patients with intra-abdominal metastases. Surgery 2020; 168:509-517. [PMID: 32439207 DOI: 10.1016/j.surg.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/23/2020] [Accepted: 04/06/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ventral hernias in patients with intra-abdominal metastases may not be addressed owing to other oncologic priorities, but they can affect quality of life and lead to sequelae necessitating an emergency operation. We compared the national trends and perioperative outcomes for elective and nonelective ventral hernia repairs for patients with intra-abdominal metastases. METHODS Patients were identified from the National Inpatient Sample (2003-2015). Temporal trends were described using average annual percent change. Perioperative outcomes between elective and nonelective ventral hernia repairs were compared using multivariable regressions. RESULTS An estimated 947,112 ventral hernia repairs were performed nationally, including 5,602 (0.6%) in patients with intra-abdominal metastases. Among patients with intra-abdominal metastases, 40.1% had a nonelective ventral hernia repair, mean (standard deviation) age was 64 (12) years, and 65.1% were women. Between 2003 and 2015, the total number of ventral hernia repairs performed nationally did not change (average annual percent change 0.062, P = .84). For patients with intra-abdominal metastases, although there was no change in the number of elective ventral hernia repairs (average annual percent change 0.65, P = .59), the number of nonelective ventral hernia repairs increased significantly (average annual percent change 2.7, P = .025). By multivariable analyses, patients with intra-abdominal metastases who underwent a nonelective repair were more likely to experience complications (odds ratio 1.76, P = .001), nonroutine discharge (odds ratio 1.93, P < .001), and mortality (odds ratio 2.27, P = .035). Nonelective ventral hernia repairs was also associated with a 38.5% (P < .001) longer hospital stay and 24.4% (P < .001) higher charges. CONCLUSION The number of nonelective ventral hernia repairs, which is associated with substantial perioperative morbidity, has increased significantly among patients with intra-abdominal metastases. Surgeons should consider a nonemergency operation for select patients to mitigate the burden of nonelective ventral hernia repairs.
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Affiliation(s)
- Yun Song
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia PA.
| | - Adrienne B Shannon
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia PA
| | - Robert E Roses
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia PA
| | - Douglas L Fraker
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia PA
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia PA
| | - Giorgos C Karakousis
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia PA
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Wang Y, Eldridge N, Metersky ML, Sonnenfeld N, Rodrick D, Fine JM, Eckenrode S, Galusha DH, Tasimi A, Hunt DR, Bernheim SM, Normand SLT, Krumholz HM. Association Between Medicare Expenditures and Adverse Events for Patients With Acute Myocardial Infarction, Heart Failure, or Pneumonia in the United States. JAMA Netw Open 2020; 3:e202142. [PMID: 32259263 PMCID: PMC7139276 DOI: 10.1001/jamanetworkopen.2020.2142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Studies have shown that adverse events are associated with increasing inpatient care expenditures, but contemporary data on the association between expenditures and adverse events beyond inpatient care are limited. OBJECTIVE To evaluate whether hospital-specific adverse event rates are associated with hospital-specific risk-standardized 30-day episode-of-care Medicare expenditures for fee-for-service patients discharged with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the 2011 to 2016 hospital-specific risk-standardized 30-day episode-of-care expenditure data from the Centers for Medicare & Medicaid Services and medical record-abstracted in-hospital adverse event data from the Medicare Patient Safety Monitoring System. The setting was acute care hospitals treating at least 25 Medicare fee-for-service patients for AMI, HF, or pneumonia in the United States. Participants were Medicare fee-for-service patients 65 years or older hospitalized for AMI, HF, or pneumonia included in the Medicare Patient Safety Monitoring System in 2011 to 2016. The dates of analysis were July 16, 2017, to May 21, 2018. MAIN OUTCOMES AND MEASURES Hospitals' risk-standardized 30-day episode-of-care expenditures and the rate of occurrence of adverse events for which patients were at risk. RESULTS The final study sample from 2194 unique hospitals included 44 807 patients (26.1% AMI, 35.6% HF, and 38.3% pneumonia) with a mean (SD) age of 79.4 (8.6) years, and 52.0% were women. The patients represented 84 766 exposures for AMI, 96 917 exposures for HF, and 109 641 exposures for pneumonia. Patient characteristics varied by condition but not by expenditure category. The mean (SD) risk-standardized expenditures were $22 985 ($1579) for AMI, $16 020 ($1416) for HF, and $16 355 ($1995) for pneumonia per hospitalization. The mean risk-standardized rates of occurrence of adverse events for which patients were at risk were 3.5% (95% CI, 3.4%-3.6%) for AMI, 2.5% (95% CI, 2.5%-2.5%) for HF, and 3.0% (95% CI, 2.9%-3.0%) for pneumonia. An increase by 1 percentage point in the rate of occurrence of adverse events was associated with an increase in risk-standardized expenditures of $103 (95% CI, $57-$150) for AMI, $100 (95% CI, $29-$172) for HF, and $152 (95% CI, $73-$232) for pneumonia per discharge. CONCLUSIONS AND RELEVANCE Hospitals with high adverse event rates were more likely to have high 30-day episode-of-care Medicare expenditures for patients discharged with AMI, HF, or pneumonia.
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Affiliation(s)
- Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Noel Eldridge
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Washington, DC
| | - Mark L. Metersky
- Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington
| | - Nancy Sonnenfeld
- Centers for Medicare & Medicaid Services, Department of Health and Human Services, Washington, DC
| | - David Rodrick
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Washington, DC
| | - Jonathan M. Fine
- Asthma, Pulmonary and Critical Medicine, Norwalk Hospital, Norwalk, Connecticut
| | | | - Deron H. Galusha
- General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - David R. Hunt
- Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Washington, DC
| | - Susannah M. Bernheim
- General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sharon-Lise T. Normand
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Harlan M. Krumholz
- General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Retrospective Analysis of Microbial Colonization Patterns in Central Venous Catheters, 2013-2017. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:8632701. [PMID: 31636880 PMCID: PMC6766096 DOI: 10.1155/2019/8632701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022]
Abstract
Objectives This study was performed to provide epidemiological information on microbial colonization in central venous catheters (CVCs). Methods CVCs submitted to Medical Microbiology Laboratory from January 1, 2013, through October 1, 2017, which met our criteria would be included for analysis. Quantitative culture was used for CVCs. The results of culture and related information on CVCs were collected and recorded in detail. The prevalence was calculated, and related factors were analyzed statistically. Results A total of 2020 CVCs were submitted for culture and eligible for analysis. Positive microbial culture occurred in 379 catheters with 18.7% (379 of 2020) prevalence of colonization. There were 23 microbial genera and 45 organisms detected. Among the isolated organisms, there were 39 kinds of isolated bacteria and 6 kinds of isolated fungi. Acinetobacter (19.8%) predominated in total isolated microorganisms, followed by Staphylococcus epidermidis (11.3%) and Candida albicans (10.3%). There were no significant differences in isolated organisms and fungal species between different sexes (X2 = 2.365, P = 0.50). Conversely, there were significant differences in isolated bacterial and fungal species between different wards and years (X2 = 124.046, P = 0.000; X2 = 77.064, P = 0.000). A total of 107 (5.3%, 107/2020) CVCs were associated with a diagnosis of central line-associated bloodstream infection (CLABSI). The most common organisms in causing CLABSI were Acinetobacter (23.4%), S. aureus (13.1%), and Candida albicans (12.1%). Conclusion The prevalence of microbial colonization in CVCs is still significant and even has gradually changed over time. The study provides a new view of microbial colonization pattern in CVCs and a prevalence of CLABSI, which will facilitate catheter-related infection prevention and control in clinic.
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Turley CB, Brittingham J, Moonan A, Davis D, Chakraborty H. Statewide Longitudinal Progression of the Whole-Patient Measure of Safety in South Carolina. J Healthc Qual 2019; 40:256-264. [PMID: 28933708 PMCID: PMC6133206 DOI: 10.1097/jhq.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Meaningful improvement in patient safety encompasses a vast number of quality metrics, but a single measure to represent the overall level of safety is challenging to produce. Recently, Perla et al. established the Whole-Person Measure of Safety (WPMoS) to reflect the concept of global risk assessment at the patient level. We evaluated the WPMoS across an entire state to understand the impact of urban/rural setting, academic status, and hospital size on patient safety outcomes. The population included all South Carolina (SC) inpatient discharges from January 1, 2008, through to December 31, 2013, and was evaluated using established definitions of highly undesirable events (HUEs). Over the study period, the proportion of hospital discharges with at least one HUE significantly decreased from 9.7% to 8.8%, including significant reductions in nine of the 14 HUEs. Academic, large, and urban hospitals had a significantly lower proportion of hospital discharges with at least one HUE in 2008, but only urban hospitals remained significantly lower by 2013. Results indicate that there has been a decrease in harm events captured through administrative coded data over this 6-year period. A composite measure, such as the WPMoS, is necessary for hospitals to evaluate their progress toward reducing preventable harm.
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Song Y, Bruce AN, Fraker DL, Karakousis GC. Isolated limb perfusion and infusion in the treatment of melanoma and soft tissue sarcoma in the era of modern systemic therapies. J Surg Oncol 2019; 120:540-549. [DOI: 10.1002/jso.25600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/05/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Yun Song
- Department of SurgeryHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Adrienne N. Bruce
- Department of SurgeryHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Douglas L. Fraker
- Department of SurgeryHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Giorgos C. Karakousis
- Department of SurgeryHospital of the University of Pennsylvania Philadelphia Pennsylvania
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17
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Song Y, Tieniber AD, Roses RE, Fraker DL, Kelz RR, Karakousis GC. National trends in centralization and perioperative outcomes of complex operations for cancer. Surgery 2019; 166:800-811. [PMID: 31230839 DOI: 10.1016/j.surg.2019.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/02/2019] [Accepted: 03/29/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Complex cancer operations performed at high-volume and teaching hospitals have been associated with better outcomes. The purpose of this study was to determine the national trends in the performance of these operations at large teaching hospitals. METHODS Patients who underwent elective esophagectomies, gastrectomies, pancreatectomies, and hepatectomies for cancer (2003-2015) were identified using the National Inpatient Sample. We determined average annual percent change (AAPC) in the proportion of operations at large teaching hospitals, inpatient complications, length of stay (LOS), and inpatient mortality. RESULTS Between 2003 and 2015, 38,932 esophageal, 104,941 gastric, 96,098 hepatic, and 137,440 pancreatic cancer resections were performed. The proportion at large teaching hospitals increased with an AAPC of 2.5 for esophagectomies (P < .001), 3.6 for gastrectomies (P < .001), and 1.5 for pancreatectomies (P = .039), but did not change for hepatectomies (AAPC 0.48, P = .50). During the study period, mean LOS and inpatient mortality rates at large teaching hospitals decreased across hospital types. By 2013 to 2015, the operations at large hospitals were associated with decreased mortality only for pancreatectomies (odds ratio, 0.62, 95% confidence interval, 0.43-0.91, P = .015). CONCLUSIONS Complex cancer operations are performed increasingly at large teaching hospitals, but perioperative outcomes have improved nationally across hospital types. Further studies should identify actionable areas for improvement to ensure accessible quality cancer care.
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Affiliation(s)
- Yun Song
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Andrew D Tieniber
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Robert E Roses
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Douglas L Fraker
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Giorgos C Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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Abstract
OBJECTIVE To estimate the additional hospital costs associated with inpatient medical harms occurring during an index inpatient admission and costs from subsequent readmissions within 90 days. DATA SOURCE 2009 to 2011 Healthcare Cost and Utilization Project's State Inpatient Databases from 12 states. STUDY DESIGN We compare hospital costs incurred by patients experiencing a specific harm during their hospital stay to the costs incurred by similar patients who did not experience that harm. DATA EXTRACTION We extracted records for adult patients admitted for a reason other than rehabilitation or mental health, were at risk of a harm, and were admitted for less than a year. PRINCIPAL FINDINGS The costliest inpatient harms, such as surgical site infections and severe pressure ulcers, are associated with approximately $30 000 in additional index stay costs per harm. Less costly harms, such as catheter- or hospital-associated urinary tract infections and venous thromboembolism, can add $6000 to $13 000. Birth and obstetric traumas add as little as $100. CONCLUSIONS Our analysis represents rigorous estimates of the hospital costs of a variety of inpatient harms; these should be of interest to health care administrators and policy makers to identify areas for cost savings to the health care system.
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Affiliation(s)
- Priyanka Anand
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
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19
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Bath J, Dombrovskiy VY, Vogel TR. Impact of Patient Safety Indicators on readmission after abdominal aortic surgery. JOURNAL OF VASCULAR NURSING 2018; 36:189-195. [PMID: 30458941 DOI: 10.1016/j.jvn.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
Patient safety is a critical component of health-care quality and measures created by the Agency for Healthcare Research and Quality (AHRQ) to identify hospitalizations with potentially preventable adverse events. This analysis evaluated whether Patient Safety Indicator (PSI) events after open surgical repair (OSR) or endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) were associated with increased risk of readmission. Patients undergoing elective repair of nonruptured AAA from 2009 to 2012 were selected in the Medicare Provider Analysis and Review files using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. To identify PSI events, we used the AHRQ PSI International Classification of Diseases, Ninth Revision, Clinical Modification numerator codes. Chi-square test, multivariable logistic regression analysis, nonparametric Wilcoxon rank sum test, and Kaplan-Meier survival analysis were used for statistics. A total of 66,923 patients undergoing elective AAA repair were evaluated: (1) 9,315 with OSR and (2) 57,608 with EVAR. The most frequent PSI events after OSR versus EVAR were postoperative respiratory failure (PSI, 11; 17.7% vs 1.8%; P < .0001); perioperative hemorrhage/hematoma (PSI, 9; 3.6% vs 2.6%; P < .0001); postoperative sepsis (PSI, 13; 3.5% vs 0.4%; P < .0001); accidental puncture or laceration (PSI, 15; 2.1% vs 0.6%; P < .0001); and postoperative acute kidney injury requiring dialysis (PSI, 10; 1.4% vs 0.2%; P < .0001). The overall 30-day readmission rate was 10.5%. The occurrence of any PSI event overall significantly increased 30-day readmission compared with no event cases (odds ratio [OR] = 1.71; 95% confidence interval [CI], 1.57-1.86). Likelihood of 30-day readmission was greater for postoperative acute kidney injury requiring dialysis (OR = 1.66; 95% CI, 1.28-2.15), postoperative respiratory failure (OR = 1.36; 95% CI, 1.22-1.52), perioperative hemorrhage (OR = 1.34; 95% CI, 1.18-1.52), and postoperative pressure ulcer (OR = 2.88; 95% CI, 1.99-4.17). Occurrence of any PSI event was associated with an increased total hospital and intensive care unit length of stay and total hospital charges (all P < .001). In conclusion, AHRQ PSI events may be used to identify patients at the greatest risk for readmission after AAA repair. The risk for 30-day readmission was 71% higher when a PSI event occurred and was not associated with the type of repair. Minimizing preventable PSI events may be beneficial to reducing hospital readmissions after open and endovascular AAA repair and to improving hospital resource utilization.
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Affiliation(s)
- Jonathan Bath
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Viktor Y Dombrovskiy
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Todd R Vogel
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, MO, USA.
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Slade D, Murray KA, Pun JKH, Eggins S. Nurses’ perceptions of mandatory bedside clinical handovers: An Australian hospital study. J Nurs Manag 2018; 27:161-171. [DOI: 10.1111/jonm.12661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/18/2018] [Accepted: 05/16/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
| | - Kristen A. Murray
- Department of English; The Hong Kong Polytechnic University; Hong Kong SAR China
| | - Jack K. H. Pun
- Department of English; City University of Hong Kong; Hong Kong SAR China
| | - Suzanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
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21
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White BA, Dea N, Street JT, Cheng CL, Rivers CS, Attabib N, Kwon BK, Fisher CG, Dvorak MF. The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study. J Neurotrauma 2017; 34:2892-2900. [DOI: 10.1089/neu.2016.4934] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Nicolas Dea
- Service de Neurochirurgie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - John T. Street
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Najmedden Attabib
- Dalhousie University, Halifax, Nova Scotia; Horizon Health Network, Division of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G. Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F. Dvorak
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Comerlato PH, Rebelatto TF, Santiago de Almeida FA, Klein LB, Boniatti MM, Schaan BD, Rados DV. Complications of central venous catheter insertion in a teaching hospital. Rev Assoc Med Bras (1992) 2017; 63:613-620. [DOI: 10.1590/1806-9282.63.07.613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/19/2016] [Indexed: 11/22/2022] Open
Abstract
Summary Introduction: Central venous catheters are fundamental to daily clinical practice. This procedure is mainly performed by residents, often without supervision or structured training. Objective: To describe the characteristics of central venous catheterization and the complication rate related to it. Method: Retrospective cohort study. Adult patients undergoing central venous catheter insertion out of the intensive care unit (ICU) of a teaching hospital were selected from March 2014 to February 2015. Data were collected from medical charts using an electronic form. Clinical and laboratory characteristics from patients, procedure characteristics, and mechanical and infectious complications rates were assessed. Patients with and without complications were compared. Results: Three hundred and eleven (311) central venous catheterizations were evaluated. The main reasons to perform the procedure were lack of peripheral access, chemotherapy and sepsis. There were 20 mechanical complications (6% of procedures). Arterial puncture was the most common. Procedures performed in the second semester were associated with lower risk of complications (odds ratio 0.35 [95CI 0.12-0.98; p=0.037]). Thirty-five (35) catheter-related infection cases (11.1%) were reported. They were related to younger patients and procedures performed by residents with more than one year of training. Procedures performed after the first trimester had a lower chance of infection. Conclusion: These results show that the rate of mechanical complications of central venous puncture in our hospital is similar to the literature, but more attention should be given to infection prevention measures.
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Orlovic M, Carter AW, Marti J, Mossialos E. Estimating the incidence and the economic burden of third and fourth-degree obstetric tears in the English NHS: an observational study using propensity score matching. BMJ Open 2017; 7:e015463. [PMID: 28606903 PMCID: PMC5541625 DOI: 10.1136/bmjopen-2016-015463] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/30/2017] [Accepted: 04/13/2017] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Obstetric care is a high-risk area in healthcare delivery, so it is essential to have up-to-date quantitative evidence in this area to inform policy decisions regarding these services. In light of this, the objective of this study is to investigate the incidence and economic burden of third and fourth-degree lacerations in the English National Health Service (NHS) using recent national data. METHODS We used coded inpatient data from Hospital Episode Statistics (HES) for the financial years from 2010/2011 to 2013/2014 for all females that gave birth during that period in the English NHS. Using HES, we used pre-existing safety indicator algorithms to calculate the incidence of third and fourth-degree obstetric tears and employed a propensity score matching method to estimate the excess length of stay and economic burden associated with these events. RESULTS Observed rates per 1000 inpatient episodes in 2010/2011 and 2013/2014, respectively: Patient Safety Indicator-trauma during vaginal delivery with instrument (PSI 18)=84.16 and 91.24; trauma during vaginal delivery without instrument (PSI 19)=29.78 and 33.43; trauma during caesarean delivery (PSI 20)=3.61 and 4.56. Estimated overall (all PSIs) economic burden for 2010/2011=£10.7 million and for 2013/2014=£14.5 million, expressed in 2013/2014 prices. CONCLUSIONS Despite many initiatives targeting the quality of maternity care in the NHS, the incidence of third and fourth-degree lacerations has increased during the observed period which signals that quality improvement efforts in obstetric care may not be reducing incidence rates. Our conservative estimates of the financial burden of these events appear low relative to total NHS expenditure for these years.
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Affiliation(s)
- Martina Orlovic
- Department of Surgery and Cancer, Faculty of Medicine, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alexander William Carter
- Department of Surgery and Cancer, Faculty of Medicine, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Joachim Marti
- Department of Surgery and Cancer, Faculty of Medicine, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Elias Mossialos
- Department of Surgery and Cancer, Faculty of Medicine, Institute of Global Health Innovation, Imperial College London, London, UK
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Ho V, Short MN, Aloia TA. Can postoperative process of care utilization or complication rates explain the volume-cost relationship for cancer surgery? Surgery 2017; 162:418-428. [PMID: 28438333 DOI: 10.1016/j.surg.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 02/27/2017] [Accepted: 03/04/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Past studies identify an association between provider volume and outcomes, but less is known about the volume-cost relationship for cancer surgery. We analyze the volume-cost relationship for 6 cancer operations and explore whether it is influenced by the occurrence of complications and/or utilization of processes of care. METHODS Medicare hospital and inpatient claims for the years 2005 through 2009 were analyzed for 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection. Regressions were first estimated to quantify the association of provider volume with costs, excluding measures of complications and processes of care as explanatory variables. Next, these variables were added to the regressions to test whether they weakened any previously observed volume-cost relationship. RESULTS Higher hospital volume is associated with lower patient costs for esophagectomy but not for other operations. Higher surgeon volume reduces costs for most procedures, but this result weakens when processes of care are added to the regressions. Processes of care that are frequently implemented in response to adverse events are associated with 14% to 34% higher costs. Utilization of these processes is more prevalent among low-volume versus high-volume surgeons. CONCLUSION Processes of care implemented when complications occur explain much of the surgeon volume-cost relationship. Given that surgeon volume is readily observed, better outcomes and lower costs may be achieved by referring patients to high-volume surgeons. Increasing patient access to surgeons with lower rates of complications may be the most effective strategy for avoiding costly processes of care, controlling expenditure growth.
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Affiliation(s)
- Vivian Ho
- Baker Institute for Public Policy, Rice University, Houston, TX; Department of Economics, Rice University, Houston, TX.
| | - Marah N Short
- Baker Institute for Public Policy, Rice University, Houston, TX
| | - Thomas A Aloia
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
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Hauck KD, Wang S, Vincent C, Smith PC. Healthy Life-Years Lost and Excess Bed-Days Due to 6 Patient Safety Incidents: Empirical Evidence From English Hospitals. Med Care 2017; 55:125-130. [PMID: 27753744 PMCID: PMC5266418 DOI: 10.1097/mlr.0000000000000631] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is little satisfactory evidence on the harm of safety incidents to patients, in terms of lost potential health and life-years. OBJECTIVE To estimate the healthy life-years (HLYs) lost due to 6 incidents in English hospitals between the years 2005/2006 and 2009/2010, to compare burden across incidents, and estimate excess bed-days. RESEARCH DESIGN The study used cross-sectional analysis of the medical records of all inpatients treated in 273 English hospitals. Patients with 6 types of preventable incidents were identified. Total attributable loss of HLYs was estimated through propensity score matching by considering the hypothetical remaining length and quality of life had the incident not occurred. RESULTS The 6 incidents resulted in an annual loss of 68 HLYs and 934 excess bed-days per 100,000 population. Preventable pressure ulcers caused the loss of 26 HLYs and 555 excess bed-days annually. Deaths in low-mortality procedures resulted in 25 lost life-years and 42 bed-days. Deep-vein thrombosis/pulmonary embolisms cost 12 HLYs, and 240 bed-days. Postoperative sepsis, hip fractures, and central-line infections cost <6 HLYs and 100 bed-days each. DISCUSSION The burden caused by the 6 incidents is roughly comparable with the UK burden of Multiple Sclerosis (80 DALYs per 100,000), HIV/AIDS and Tuberculosis (63 DALYs), and Cervical Cancer (58 DALYs). There were marked differences in the harm caused by the incidents, despite the public attention all of them receive. Decision makers can use the results to prioritize resources into further research and effective interventions.
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Affiliation(s)
- Katharina D. Hauck
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London
| | | | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford
| | - Peter C. Smith
- Imperial College Business School, Imperial College London, London, UK
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Nguyen MC, Moffatt-Bruce SD, Strosberg DS, Puttmann KT, Pan YL, Eiferman DS. Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for Postoperative Respiratory Failure (PSI 11) does not identify accurately patients who received unsafe care. Surgery 2016; 160:858-868. [PMID: 27528212 DOI: 10.1016/j.surg.2016.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/18/2016] [Accepted: 05/05/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Agency for Healthcare Research and Quality Patient Safety Indicator 11 is used to identify postoperative respiratory failure events and detect areas for quality improvement. This study examines the accuracy of Patient Safety Indicator 11 in identifying clinically valid patient safety events. METHODS All cases flagged for Patient Safety Indicator 11 from July 2013 to July 2015 by Agency for Healthcare Research and Quality QI Version 4.5 including International Classification of Diseases-9 codes were evaluated. Code-confirmed cases underwent independent review by 2 physicians. Inpatient electronic medical records were used to identify clinical factors for postoperative respiratory failure in each case to determine if postoperative respiratory failure was a result of unsafe care. The clinical true-positive rate and positive predictive value were calculated. RESULTS A total of 166 postoperative respiratory failure cases were reviewed; 51 were recoded and reversed due to coding or documentation errors; 115 cases met the Agency for Healthcare Research and Quality definition of postoperative respiratory failure. A total of 71 (61.7%) of the 115 cases were false positives and did not reflect unsafe care, while 44 cases were true positives with a positive predictive value of 38.3%. χ(2) analysis did not reveal an association between demographics, clinical characteristics, or operative procedure with true-positive cases. CONCLUSION Administrative coding data for Agency for Healthcare Research and Quality Patient Safety Indicator 11 do not identify accurately patients who received unsafe care when taking into account unpreventable clinical factors causing postoperative respiratory failure. The use of Agency for Healthcare Research and Quality Patient Safety Indicator 11 as a hospital performance measure should be reconsidered until inclusion and exclusion criteria are revised.
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Affiliation(s)
- Michelle C Nguyen
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH.
| | | | - David S Strosberg
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH
| | - Kathleen T Puttmann
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH
| | - Yangshu L Pan
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH
| | - Daniel S Eiferman
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH
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Kubasiak JC, Francescatti AB, Behal R, Myers JA. Patient Safety Indicators for Judging Hospital Performance. Am J Med Qual 2016; 32:129-133. [PMID: 26719348 DOI: 10.1177/1062860615618782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient Safety Indicators (PSIs) were originally intended for use as a screen for quality of care but are now being used to rank hospitals and to modify hospital reimbursement. PSI data are dependent on accuracy of clinical documentation and coding. Information on whether a PSI event is inherent to the nature of the operation or posed a significant impact on the outcome is lacking. Cases for one year at a single academic center were queried. Cases with target PSIs were included (n = 136). Cases were evaluated for both the inherent nature and significance of injury. Both patient safety officers agreed that the PSI event was inherent to the disease process, and thus, the procedure and was not a marker of patient safety (false positive) in 11.8% to 33.3% of cases. Both reviewers agreed that the events were not clinically significant in 11.8% to 30.4% of cases. This study found high false-positive rates and only moderate interrater reliability for 3 PSIs. PSIs as currently reported are not reliable enough to be utilized for ranking.
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Affiliation(s)
| | | | - Raj Behal
- 2 Stanford University Medical Center, Stanford, CA
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Mendizabal A, Thibault DP, Willis AW. Patient safety events in hospital care of individuals with epilepsy. Epilepsia 2016; 57:1301-9. [DOI: 10.1111/epi.13440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Adys Mendizabal
- Temple University School of Medicine; Philadelphia Pennsylvania U.S.A
| | - Dylan P. Thibault
- Department of Neurology; University of Pennsylvania School of Medicine; Philadelphia Pennsylvania U.S.A
- Department of Biostatistics and Epidemiology; University of Pennsylvania School of Medicine; Philadelphia Pennsylvania U.S.A
| | - Allison W. Willis
- Department of Neurology; University of Pennsylvania School of Medicine; Philadelphia Pennsylvania U.S.A
- Department of Biostatistics and Epidemiology; University of Pennsylvania School of Medicine; Philadelphia Pennsylvania U.S.A
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
- Center for Clinical Epidemiology and Biostatistics; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
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Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without C. difficile Infection. Infect Control Hosp Epidemiol 2016; 37:404-10. [PMID: 26858126 DOI: 10.1017/ice.2015.340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Inpatient length of stay (LOS) has been used as a measure of hospital quality and efficiency. Patients with Clostridium difficile infections (CDI) have longer LOS. OBJECTIVE To describe the relationship between hospital CDI incidence and the LOS of patients without CDI. DESIGN Retrospective cohort analysis. METHODS We predicted average LOS for patients without CDI at both the hospital and patient level using hospital CDI incidence. We also controlled for hospital characteristics (eg, bed size) and patient characteristics (eg, comorbidities, age). SETTING Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2009-2011. PATIENTS The Nationwide Inpatient Sample includes patients from a 20% sample of all nonfederal US hospitals. RESULTS Inpatient LOS was significantly longer (P<.001) at hospitals with greater CDI incidence at both the hospital and individual level. At a hospital level, a percentage point increase in the CDI incidence rate was associated with more than an additional day's stay (between 1.19 and 1.61 days). At the individual level, controlling for all observable variables, a percentage point increase in the CDI incidence rate at their hospital was also associated with longer LOS (between 0.6 and 1.05 additional days). Hospital CDI incidence had a larger impact on LOS than many other commonly used predictors of LOS. CONCLUSION CDI rates are a predictor of LOS in patients without CDI at an individual and institutional level. CDI rates are easy to measure and report and thus may provide an important marker for hospital efficiency and/or quality.
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Abstract
Improving quality of health care is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events (AEs). This project assessed risk-adjusted rates of inpatient AEs for soft tissue reconstructive procedures.Patients receiving soft tissue reconstructive procedures from 2005 to 2010 were extracted from the Nationwide Inpatient Sample. Inpatient AEs were identified using patient safety indicators (PSIs), established measures developed by Agency for Healthcare Research and Quality.We identified 409,991 patients with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. Patient safety indicators were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (P < 0.01). Patient characteristics associated with a higher risk-adjusted rate per 1000 patients at risk included older age, men, nonwhite, and public payer (P < 0.05). Overall, plastic surgery patients had significantly lower risk-adjusted rate compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. Risk-adjusted rates of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by sex and payer. In general, plastic surgery patients had lower rates of in-hospital AEs than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of AEs identified in this population.
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Ock M, Lee SI, Jo MW, Lee JY, Kim SH. Assessing Reliability of Medical Record Reviews for the Detection of Hospital Adverse Events. J Prev Med Public Health 2015; 48:239-48. [PMID: 26429290 PMCID: PMC4592027 DOI: 10.3961/jpmph.14.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 07/22/2015] [Indexed: 01/13/2023] Open
Abstract
Objectives: The purpose of this study was to assess the inter-rater reliability and intra-rater reliability of medical record review for the detection of hospital adverse events. Methods: We conducted two stages retrospective medical records review of a random sample of 96 patients from one acute-care general hospital. The first stage was an explicit patient record review by two nurses to detect the presence of 41 screening criteria (SC). The second stage was an implicit structured review by two physicians to identify the occurrence of adverse events from the positive cases on the SC. The inter-rater reliability of two nurses and that of two physicians were assessed. The intra-rater reliability was also evaluated by using test-retest method at approximately two weeks later. Results: In 84.2% of the patient medical records, the nurses agreed as to the necessity for the second stage review (kappa, 0.68; 95% confidence interval [CI], 0.54 to 0.83). In 93.0% of the patient medical records screened by nurses, the physicians agreed about the absence or presence of adverse events (kappa, 0.71; 95% CI, 0.44 to 0.97). When assessing intra-rater reliability, the kappa indices of two nurses were 0.54 (95% CI, 0.31 to 0.77) and 0.67 (95% CI, 0.47 to 0.87), whereas those of two physicians were 0.87 (95% CI, 0.62 to 1.00) and 0.37 (95% CI, -0.16 to 0.89). Conclusions: In this study, the medical record review for detecting adverse events showed intermediate to good level of inter-rater and intra-rater reliability. Well organized training program for reviewers and clearly defining SC are required to get more reliable results in the hospital adverse event study.
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Affiliation(s)
- Minsu Ock
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-il Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Yong Lee
- Public Health Medical Service, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seon-Ha Kim
- Department of Nursing, Dankook University, Cheonan, Korea
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Economic Evaluation of Four Drug Administration Systems in Intensive Care Units in Colombia. Value Health Reg Issues 2014; 5:20-24. [DOI: 10.1016/j.vhri.2014.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rosen AK, Chen Q, Borzecki AM, Shin M, Itani KMF, Shwartz M. Using estimated true safety event rates versus flagged safety event rates: does it change hospital profiling and payment? Health Serv Res 2014; 49:1426-45. [PMID: 24779721 PMCID: PMC4213043 DOI: 10.1111/1475-6773.12180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess whether use of the AHRQ Patient Safety Indicator (PSI) composite measure versus modified composite measures leads to changes in hospital profiles and payments. DATA SOURCES/STUDY SETTING Retrospective analysis of 2010 Veterans Health Administration discharge data. STUDY DESIGN We used the AHRQ PSI software (v4.2) to obtain PSI-flagged events and composite scores for all 151 hospitals in the database (n = 517,814 hospitalizations). We compared the AHRQ PSI composite to two modified composites that estimated "true safety events" from previous chart abstraction findings: one with modified numerators based on the positive predictive value (PPV) of each PSI, and one with similarly modified numerators but whose denominators were based on the expected fraction of PSI-eligible cases that remained after removing those PSIs that were present-on-admission (POA). PRINCIPAL FINDINGS Although a small percentage (5-6 percent) of hospitals changed outlier status based on modified PSI composites, some of these changes were substantial; 30 and 19 percent of hospitals changed ≥20 ranks after adjustment for PPVs and POA flags, respectively. We estimate that 33 percent of hospitals would see a change of at least 10 percent in performance payments. CONCLUSIONS Changes in hospital profiles and payments would be substantial for some hospitals if the PSI composite score used weights reflecting the relative prevalence of true versus flagged events.
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Affiliation(s)
- Amy K Rosen
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare SystemBoston, MA
| | - Qi Chen
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare SystemBoston, MA
| | - Ann M Borzecki
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Medical CenterBedford, MA
- Department of Health Policy and Management, Boston University School of Public HealthBedford, MA
| | - Marlena Shin
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare SystemBoston, MA
| | - Kamal M F Itani
- Department of Surgery, Boston University School of MedicineBoston, MA
- Department of Surgery, VA Boston Healthcare SystemBoston, MA
- Harvard Medical SchoolBoston, MA
| | - Michael Shwartz
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare SystemBoston, MA
- Department of Operations and Technology Management, Boston University School of ManagementBoston, MA
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Borghans I, Hekkert KD, den Ouden L, Cihangir S, Vesseur J, Kool RB, Westert GP. Unexpectedly long hospital stays as an indicator of risk of unsafe care: an exploratory study. BMJ Open 2014; 4:e004773. [PMID: 24902727 PMCID: PMC4054630 DOI: 10.1136/bmjopen-2013-004773] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. A higher percentage of patients with an unexpectedly long length of stay (UL-LOS) compared to the national average may indicate shortcomings in patient safety. We explored the utility of the UL-LOS indicator. SETTING We used data of 61 Dutch hospitals. In total these hospitals had 1 400 000 clinical discharges in 2011. PARTICIPANTS The indicator is based on the percentage of patients with a prolonged length of stay of more than 50% of the expected length of stay and calculated among survivors. INTERVENTIONS No interventions were made. OUTCOME MEASURES The outcome measures were the variability of the indicator across hospitals, the stability over time, the correlation between the UL-LOS and standardised mortality and the influence on the indicator of hospitals that did have problems discharging their patients to other health services such as nursing homes. RESULTS In order to compare hospitals properly the expected length of stay was computed based on comparison with benchmark populations. The standardisation was based on patients' age, primary diagnosis and main procedure. The UL-LOS indicator showed considerable variability between the Dutch hospitals: from 8.6% to 20.1% in 2011. The outcomes had relatively small CIs since they were based on large numbers of patients. The stability of the indicator over time was quite high. The indicator had a significant positive correlation with the standardised mortality (r=0.44 (p<0.001)), and no significant correlation with the percentage of patients that was discharged to other facilities than other hospitals and home (r=-0.15 (p>0.05)). CONCLUSIONS The UL-LOS indicator is a useful addition to other patient safety indicators by revealing variation between hospitals and areas of possible patient safety improvement.
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Affiliation(s)
- Ine Borghans
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud university medical centre, Nijmegen, The Netherlands
- Dutch Health Care Inspectorate (IGZ), Utrecht, The Netherlands
| | | | - Lya den Ouden
- Dutch Health Care Inspectorate (IGZ), Utrecht, The Netherlands
| | | | - Jan Vesseur
- Dutch Health Care Inspectorate (IGZ), Utrecht, The Netherlands
| | - Rudolf B Kool
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud university medical centre, Nijmegen, The Netherlands
| | - Gert P Westert
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud university medical centre, Nijmegen, The Netherlands
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Short MN, Aloia TA, Ho V. The influence of complications on the costs of complex cancer surgery. Cancer 2014; 120:1035-41. [PMID: 24382697 PMCID: PMC3961514 DOI: 10.1002/cncr.28527] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is widely known that outcomes after cancer surgery vary widely, depending on interactions between patient, tumor, neoadjuvant therapy, and provider factors. Within this complex milieu, the influence of complications on the cost of surgical oncology care remains unknown. The authors examined rates of Patient Safety Indicator (PSI) occurrence for 6 cancer operations and their association with costs of care. METHODS The Agency for Healthcare Research and Quality (AHRQ) PSI definitions were used to identify patient safety-related complications in Medicare claims data. Hospital and inpatient physician claims for the years 2005 through 2009 were analyzed for 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection. Risk-adjusted regression analyses were used to measure the association between each PSI and hospitalization costs. RESULTS Overall PSI rates ranged from a low of 0.01% for postoperative hip fracture to a high of 2.58% for respiratory failure. Death among inpatients with serious treatable complications, postoperative respiratory failure, postoperative thromboembolism, and accidental puncture/laceration were >1% for all 6 cancer operations. Several PSIs-including decubitus ulcer, death among surgical inpatients with serious treatable complications, and postoperative thromboembolism-raised hospitalization costs by ≥20% for most cancer surgery types. Postoperative respiratory failure resulted in a cost increase >50% for all cancer resections. CONCLUSIONS The consistently higher costs associated with cancer surgery PSIs indicate that substantial health care savings could be achieved by targeting these indicators for quality improvement.
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Affiliation(s)
- Marah N Short
- James A. Baker III Institute for Public Policy, Rice UniversityHouston, Texas
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer CenterHouston, Texas
| | - Vivian Ho
- James A. Baker III Institute for Public Policy, Rice UniversityHouston, Texas
- Department of Economics, Rice UniversityHouston, Texas
- Department of Medicine, Baylor College of MedicineHouston, Texas
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Bohensky MA, Ademi Z, deSteiger R, Liew D, Sundararajan V, Bucknill A, Kondogiannis C, Brand CA. Quantifying the excess cost and resource utilisation for patients with complications associated with elective knee arthroscopy: a retrospective cohort study. Knee 2014; 21:491-6. [PMID: 24331732 DOI: 10.1016/j.knee.2013.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 10/01/2013] [Accepted: 11/13/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent studies have demonstrated morbidity associated with elective knee arthroscopy. The objective of the current study was to quantify resource utilisation and costs associated with postoperative complications following an elective knee arthroscopy. METHODS We undertook a retrospective, longitudinal cohort study using routinely collected hospital data from Victorian public hospitals during the period from 1 July 2000 to 30 June 2009. A generalised linear model was used to examine relative cost and length of stay for venous thromboembolism, joint complications and infections. Log-transformed multiple linear regression and retransformation were used to determine the excess cost after adjustment. RESULTS We identified 166,770 episodes involving an elective knee arthroscopy. There were a total of 976(0.6%) complications, including 573 patients who had a venous thromboembolism (VTE) (0.3%), 227 patients with a joint complication (0.1%) and 141 patients with infections (0.1%). After adjustment, the excess 30-day cost per patient for venous thromboembolism was $USD +3227 (95% CI: $3211-3244), for joint complications it was $USD +2247 (95% CI: $2216-2280) and for infections it was $USD +4364 (95% CI: $4331-4397). CONCLUSION This is the first study to quantify resource utilisation for complications associated with elective knee arthroscopy. With growing attention focused on improving patient outcomes and containing costs, understanding the nature and impact of complications on resource utilisation is important.
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Affiliation(s)
- Megan A Bohensky
- Melbourne EpiCentre, Department of Medicine, University of Melbourne, VIC, Australia; Centre for Research Excellence in Patient Safety, Monash University, Melbourne, Australia.
| | - Zanfina Ademi
- Melbourne EpiCentre, Department of Medicine, University of Melbourne, VIC, Australia
| | | | - Danny Liew
- Melbourne EpiCentre, Department of Medicine, University of Melbourne, VIC, Australia
| | - Vijaya Sundararajan
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Australia; Department of Medicine, Southern Clinical School, Monash University, Australia
| | - Andrew Bucknill
- Department of Orthopaedics, Melbourne Health, Melbourne, Australia
| | | | - Caroline A Brand
- Melbourne EpiCentre, Department of Medicine, University of Melbourne, VIC, Australia; Centre for Research Excellence in Patient Safety, Monash University, Melbourne, Australia
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Impacto económico de los eventos adversos en los hospitales españoles a partir del Conjunto Mínimo Básico de Datos. GACETA SANITARIA 2014; 28:48-54. [DOI: 10.1016/j.gaceta.2013.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 11/23/2022]
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Trentino KM, Swain SG, Burrows SA, Sprivulis PC, Daly FFS. Measuring the incidence of hospital-acquired complications and their effect on length of stay using CHADx. Med J Aust 2013; 199:543-7. [PMID: 24138380 DOI: 10.5694/mja12.11640] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 05/09/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To use an automated Classification of Hospital Acquired Diagnoses (CHADx) reporting system to report the incidence of hospital-acquired complications in inpatients and investigate the association between hospital-acquired complications and hospital length of stay (LOS) in multiday-stay patients. DESIGN Retrospective cross-sectional study for calendar years 2010 and 2011. SETTING South Metropolitan Health Service in Western Australia, which consists of two teaching and three non-teaching hospitals. MAIN OUTCOME MEASURES Incidence of hospital-acquired complications and mean LOS for multiday-stay patients. RESULTS Of 436 841 inpatient separations, 29 172 (6.68%) had at least one hospital-acquired complication code assigned in the administrative data, and there were a total of 56 326 complication codes. The three most common complications were postprocedural complications; cardiovascular complications; and labour, delivery and postpartum complications. In the subset of data on multiday-stay patients, crude mean LOS was longer in separations for patients with hospital-acquired complications than in separations for those without such complications (17.4 days v 5.4 days). After adjusting for potential confounders, separations for patients with hospital-acquired complications had almost four times the mean LOS of separations for those without such complications (incident rate ratio, 3.84; 95% CI, 3.73-3.96; P < 0.001). CONCLUSIONS An automated CHADx reporting system can be used to collect data on patients with hospital-acquired complications. Such data can be used to increase emphasis on patient safety and quality of care and identify potential opportunities to reduce LOS.
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Affiliation(s)
- Kevin M Trentino
- Performance Unit, South Metropolitan Health Service, Perth, WA, Australia.
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Utter GH, Zrelak PA, Baron R, Tancredi DJ, Sadeghi B, Geppert JJ, Romano PS. Detecting postoperative hemorrhage or hematoma from administrative data: the performance of the AHRQ Patient Safety Indicator. Surgery 2013; 154:1117-25. [PMID: 24075277 DOI: 10.1016/j.surg.2013.04.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/26/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient Safety Indicator (PSI) 9, "postoperative hemorrhage or hematoma" (PHH), of the US Agency for Healthcare Research and Quality has been considered for public quality of care reporting. We sought to evaluate its performance in detecting true complications. METHODS We conducted a retrospective, cross-sectional study of hospitalizations that met PSI 9 eligibility criteria. We sampled records flagged positive and negative by PSI 9 from a diverse set of 31 hospitals between February 2006, and June 2009. Trained abstractors reviewed medical records using standard instruments. We determined the sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values of the indicator. RESULTS Of 181 analyzable records flagged by PSI 9, 168 (93%; weighted PPV, 95% [95% confidence interval (CI), 90-98%]) involved an accurately coded event, but only 126 (70%; weighted PPV, 78% [95% CI, 58-90%]) represented true PHH. Thirty-two false positives involved only intraoperative hemorrhage. Among true positives, hypotension occurred in 28% and death attributed to the PHH in 4%. Thirty-two of 281 records flagged negative by PSI 9 (but enriched with questionably negative records) represented true PHH. The indicator's sensitivity was 42% (95% CI, 23-64%), specificity 99.9% (95% CI, 99.8-100%), and NPV 99.7% (95% CI, 99.0-99.9%). Modifying the indicator to include additional procedure codes improved both sensitivity (85% [95% CI, 67-94%]) and PPV (76% [95% CI, 60-88%]). CONCLUSION PSI 9 holds promise in detecting serious, possibly preventable complications. The indicator might be improved by specification of the 998.11 hemorrhage code to exclude purely intraoperative events and addition of procedure codes to the indicator's numerator criteria.
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Affiliation(s)
- Garth H Utter
- Department of Surgery, University of California, Davis, Sacramento, CA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA.
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Ramanathan R, Leavell P, Stockslager G, Mays C, Harvey D, Duane TM. Validity of Agency for Healthcare Research and Quality Patient Safety Indicators at an Academic Medical Center. Am Surg 2013. [DOI: 10.1177/000313481307900617] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The Agency for Healthcare Research and Quality developed Patient Safety Indicators (PSI) to screen for in-hospital complications and patient safety events through International Classification of Diseases, 9th Revision, Clinical Modification coding. The purpose of this study was to validate 10 common surgically related PSIs at our academic medical center and investigate the causes for inaccuracies. We reviewed patient records between October 2011 and September 2012 at our urban academic medical center for 10 common surgically related PSIs. The records were reviewed for incorrectly identified PSIs and a subset was further reviewed for the contributing factors. There were 93,169 charts analyzed for PSIs and 358 PSIs were identified (3.84 per 1000 cases). The overall positive predictive value (PPV) was 83 per cent (95% confidence interval 79 to -86%). The lowest PPVs were associated with catheter-related bloodstream infections (67%), postoperative respiratory failure (71%), and pressure ulcers (79%). The most common contributing factors for incorrect PSIs were coding errors (30%), documentation errors (19%), and insufficient criteria for PSI in the chart (16%). We conclude that the validity of PSIs is low and could be improved by increased education for clinicians and coders. In their current form, PSIs remain suboptimal for widespread use in public reporting and pay-for-performance evaluation.
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Affiliation(s)
- Rajesh Ramanathan
- Department of Surgery, Critical Care & Emergency Surgery, VCU Medical Center, Richmond, Virginia
| | - Patricia Leavell
- Department of Performance Improvement, Critical Care & Emergency Surgery, VCU Medical Center, Richmond, Virginia
| | - Gregory Stockslager
- Department of Performance Improvement, Critical Care & Emergency Surgery, VCU Medical Center, Richmond, Virginia
| | - Catherine Mays
- Department of Performance Improvement, Critical Care & Emergency Surgery, VCU Medical Center, Richmond, Virginia
| | - Dale Harvey
- Department of Performance Improvement, Critical Care & Emergency Surgery, VCU Medical Center, Richmond, Virginia
| | - Therese M. Duane
- Division of Trauma, Critical Care & Emergency Surgery, VCU Medical Center, Richmond, Virginia
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Studnicki J, Ekezue BF, Tsulukidze M, Honoré P, Moonesinghe R, Fisher J. Disparity in race-specific comorbidities associated with central venous catheter-related bloodstream infection (AHRQ-PSI7). Am J Med Qual 2013; 28:525-32. [PMID: 23526359 DOI: 10.1177/1062860613480826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies of racial disparities in hospital-level patient safety outcomes typically apply a race-common approach to risk adjustment. Risk factors specific to a minority population may not be identified in a race-common analysis if they represent only a small percentage of total cases. This study identified patient comorbidities and characteristics associated with the likelihood of a venous catheter-related bloodstream infection (Agency for Healthcare Research and Quality Patient Safety Indicator 7 [PSI7]) separately for blacks and whites using race-specific logistic regression models. Hospitals were ranked by the racial disparity in PSI7 and segmented into 4 groups. The analysis identified both black- and white-specific risk factors associated with PSI7. Age showed race-specific reverse association, with younger blacks and older whites more likely to have a PSI7 event. These findings suggest the need for race-specific covariate adjustments in patient outcomes and provide a new context for examining racial disparities.
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Examining the impact of the AHRQ Patient Safety Indicators (PSIs) on the Veterans Health Administration: the case of readmissions. Med Care 2013; 51:37-44. [PMID: 23032358 DOI: 10.1097/mlr.0b013e318270c0f7] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND By focusing primarily on outcomes in the inpatient setting one may overlook serious adverse events that may occur after discharge (eg, readmissions, mortality) as well as opportunities for improving outpatient care. OBJECTIVE Our overall objective was to examine whether experiencing an Agency for Healthcare Research and Quality Patient Safety Indicator (PSI) event in an index medical or surgical hospitalization increased the likelihood of readmission. METHODS We applied the Agency for Healthcare Research and Quality PSI software (version 4.1.a) to 2003-2007 Veterans Health Administration inpatient discharge data to generate risk-adjusted PSI rates for 9 individual PSIs and 4 aggregate PSI measures: any PSI event and composite PSIs reflecting "Technical Care," "Continuity of Care," and both surgical and medical care (Mixed). We estimated separate logistic regression models to predict the likelihood of 30-day readmission for individual PSIs, any PSI event, and the 3 composites, adjusting for age, sex, comorbidities, and the occurrence of other PSI(s). RESULTS The odds of readmission were 23% higher for index hospitalizations with any PSI event compared with those with no event [confidence interval (CI), 1.19-1.26], and ranged from 22% higher for Iatrogenic Pneumothorax (CI, 1.03-1.45) to 61% higher for Postoperative Wound Dehiscence (CI, 1.27-2.05). For the composites, the odds of readmission ranged from 15% higher for the Technical Care composite (CI, 1.08-1.22) to 37% higher for the Continuity of Care composite (CI, 1.26-1.50). CONCLUSIONS Our results suggest that interventions that focus on minimizing preventable inpatient safety events as well as improving coordination of care between and across settings may decrease the likelihood of readmission.
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Abstract
BACKGROUND Accidental puncture or laceration during a surgical procedure is a patient safety indicator that is publicly reported and will factor into the Centers for Medicare and Medicaid's pay-for-performance plan. Accidental puncture or laceration includes serosal tear, enterotomy, and injury to the ureter, bladder, spleen, or blood vessels. OBJECTIVE This study aimed to identify risk factors and assess surgical outcomes related to accidental puncture or laceration. DESIGN This is a retrospective study. SETTINGS This study was conducted in a single-hospital department of colorectal surgery. PATIENTS Inpatients undergoing colorectal surgery in which an accidental puncture or laceration did or did not occur were selected. MAIN OUTCOME MEASURES The primary outcomes measured were surgical complications, length of stay, and readmission. RESULTS Of 2897 operations, 269 had accidental puncture or laceration (9.2%) including serosal tear (47%), enterotomy (38%), and extraintestinal injuries (15%). Accidental puncture or laceration cases had more diagnoses of enterocutaneous fistula (11% vs 2%, p < 0.001), reoperative cases (91% vs 61%, p < 0.001), open surgery (96% vs 77%, p < 0.001), longer operative times (186 vs 146 minutes, p = 0.001), and increased length of stay (10 vs 7 days, p = 0.002). Patients with serosal tears had entirely similar outcomes to those without an injury, whereas patients with enterotomies had increased operative times and length of stay, and patients with extraintestinal injuries had higher rates of reoperation and sepsis (p < 0.05 for all). LIMITATIONS This study was limited by the loss of sensitivity due to grouping extraintestinal injuries. CONCLUSIONS Accidental puncture or laceration is more likely to occur in complex colorectal operations. The clinical consequences range from none to significant depending on the specific type of injury. To make accidental puncture or laceration a more meaningful quality indicator, we advocate that groups who use the measure eliminate the injuries that have no bearing on surgical outcome and that risk adjustment for operative complexity is performed.
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Cihangir S, Borghans I, Hekkert K, Muller H, Westert G, Kool RB. A pilot study on record reviewing with a priori patient selection. BMJ Open 2013; 3:bmjopen-2013-003034. [PMID: 23872292 PMCID: PMC3717450 DOI: 10.1136/bmjopen-2013-003034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate whether a priori selection of patient records using unexpectedly long length of stay (UL-LOS) leads to detection of more records with adverse events (AEs) compared to non-UL-LOS. DESIGN To investigate the opportunities of the UL-LOS, we looked for AEs in all records of patients with colorectal cancer. Within this group, we compared the number of AEs found in records of patients with a UL-LOS with the number found in records of patients who did not have a UL-LOS. SETTING Our study was done at a general hospital in The Netherlands. The hospital is medium sized with approximately 30 000 admissions on an annual basis. The hospital has two major locations in different cities where both primary and secondary care is provided. PARTICIPANTS The patient records of 191 patients with colorectal cancer were reviewed. PRIMARY AND SECONDARY OUTCOME MEASURES Number of triggers and adverse events were the primary outcome measures. RESULTS In the records of patients with colorectal cancer who had a UL-LOS, 51% of the records contained one or more AEs compared with 9% in the reference group of non-UL-LOS patients. By reviewing only the UL-LOS group with at least one trigger, we found in 84% (43 out of 51) of these records at least one adverse event. CONCLUSIONS A priori selection of patient records using the UL-LOS indicator appears to be a powerful selection method which could be an effective way for healthcare professionals to identify opportunities to improve patient safety in their day-to-day work.
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Affiliation(s)
- Sezgin Cihangir
- Dutch Hospital Data, Utrecht, The Netherlands
- (At time of research) Kiwa Prismant, Utrecht, TheNetherlands
| | - Ine Borghans
- Dutch Healthcare Inspectorate (IGZ), Utrecht, TheNetherlands
- Radboud University Nijmegen Medical Centre, Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, TheNetherlands
| | - Karin Hekkert
- Dutch Hospital Data, Utrecht, The Netherlands
- (At time of research) Kiwa Prismant, Utrecht, TheNetherlands
| | - Hein Muller
- Internal Medicine, Tergooi Hospitals, Hilversum, TheNetherlands
| | - Gert Westert
- Radboud University Nijmegen Medical Centre, Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, TheNetherlands
| | - Rudolf B Kool
- Radboud University Nijmegen Medical Centre, Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, TheNetherlands
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Hellsten EK, Hanbidge MA, Manos AN, Lewis SJ, Massicotte EM, Fehlings MG, Coyte PC, Rampersaud YR. An economic evaluation of perioperative adverse events associated with spinal surgery. Spine J 2013; 13:44-53. [PMID: 23384882 DOI: 10.1016/j.spinee.2013.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 11/27/2012] [Accepted: 01/08/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Besides their clinical impact, the economic impact of health care-related adverse events (AEs) is significant. Although a number of studies have attempted to estimate the economic impact of AEs, few have directly linked costs to clinician-reported event severity. PURPOSE To estimate the economic impact in terms of the incremental cost and length of stay (LOS), attributable to different severity grades of AEs that occurred during perioperative spinal surgery. STUDY DESIGN Health economic evaluation of data from a prospective observational study from the perspective of an academic hospital. PATIENT SAMPLE Consecutive patients at a single, tertiary-quaternary care institution who have undergone inpatient spinal surgery. OUTCOME MEASURES The cost and LOS impacts with respect to the severity of the AEs. METHODS We analyzed 4 years of patient discharges between January 1, 2007 and December 31, 2010. The Spine Adverse Events Severity instrument was completed by the surgical team at discharge. Clinical impacts of the AEs were graded as I (requires no/minimal treatment), II (requires treatment and is not likely to cause long-term [>6 months] sequelae), III (requires treatment and is most likely to cause long-term sequelae), and IV (death). A total of 1,815 records were linked with the patient-level costing information. We matched each AE case with four control cases based on their propensity score for the risk of experiencing an AE, regressed against case characteristics. We estimated an incremental cost and LOS for each severity grade by calculating the differences in means across cases and controls. We conducted a sensitivity analysis by estimating the alternate models using generalized linear model (GLM) regression with a gamma log link. RESULTS Adverse events were reported in 316 (17.4%) cases, with 126 of these patients (40.2%) experiencing multiple events. The incremental cost/LOS for each severity grade are as follows: I=$4,224 (p=.0351)/3.63 days (p=.0001); II=$23,500 (p<.0001)/14.03 days (p<.0001); III=$147,285 (p=.0036)/74.50 days (p=.0018); and IV=$121,366 (p=.0323)/46.44 days (p=.0036). The total cost in millions/LOS (days) associated with each grade over the 4-year study period are as follows: I=$0.66 million/569.9 days; II=$2.96 million/1,767.8 days; III=$4.27 million/2,160.5 days; and IV=$0.49 million/185.8 days. Our sensitivity analysis produced comparable overall results using alternate modeling techniques. Overall, AEs contributed an estimated $8.38 million (16.0% of the total costs for all patients in the sample) in incremental costs and 4,684 additional bed days over the 4-year study period. CONCLUSIONS In this surgical spine cohort, AEs accounted for 16% of the total cost of in-hospital care. Higher severity AEs were progressively more costly on a per-case basis; however, the more frequent lower severity events (ie, Grade I and II) also had a substantial aggregate cost (43%). These results suggest that a strong business case exists for patient safety strategies focused not only on severe AEs but also on the reduction of lower severity events that may be more amenable to prevention efforts.
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Affiliation(s)
- Erik K Hellsten
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Health Sciences Building, 155 College St, Suite 425, Toronto, ON M5T 3M6, Canada
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Crandall WV, Davis JT, McClead R, Brilli RJ. Is preventable harm the right patient safety metric? Pediatr Clin North Am 2012; 59:1279-92. [PMID: 23116525 DOI: 10.1016/j.pcl.2012.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite increasing attention and discussion, patient harm remains an important issue in health care. Defining and identifying harm remains challenging, and little standardization in approach exists. This summary describes an approach to identifying hospital-wide preventable harm with focused safety efforts using the Preventable Harm Index as a measure of progress and as a metric to motivate improvement. Our hospital's significant decrease in serious safety events, mortality, and preventable harm is outlined.
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Affiliation(s)
- Wallace V Crandall
- Nationwide Children's Hospital, The Ohio State University, College of Medicine, Columbus, OH 43205, USA
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Liu V, Turk BJ, Rizk NW, Kipnis P, Escobar GJ. The Association Between Sepsis and Potential Medical Injury Among Hospitalized Patients. Chest 2012; 142:606-613. [DOI: 10.1378/chest.11-2556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Dias MAE, Martins M, Navarro N. Rastreamento de resultados adversos nas internações do Sistema Único de Saúde. Rev Saude Publica 2012; 46:719-29. [DOI: 10.1590/s0034-89102012005000054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 02/03/2012] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Descrever a frequência de rastreadores de potenciais resultados adversos em internações no Sistema Único de Saúde. MÉTODOS: Estudo retrospectivo, incluindo as internações de adultos na clínica médica (n = 3.565.811) e clínica cirúrgica (n = 2.614.048) no Brasil em 2007. O Sistema de Informações Hospitalares foi utilizado como fonte de informação. A mensuração dos resultados adversos baseou-se no rastreamento de 11 condições clínicas, definidas em estudos internacionais anteriores, registradas no campo diagnóstico secundário. Foram realizadas análises bivariada e multivariada, no intuito de associar resultado adverso, óbito (variável dependente) e outras variáveis como idade, utilização de unidade de terapia intensiva e realização de cirurgia. RESULTADOS: A frequência obtida foi 3,6 potenciais resultados adversos por 1.000 internações para ambas as clínicas, superior na clínica médica (5,3 por 1.000) em relação à clínica cirúrgica (1,3 por 1.000). Houve diferenças no perfil das internações: na clínica médica predominaram idosos, maior tempo médio de permanência, maior taxa de mortalidade e menor custo total de internação. O rastreador de resultado adverso mais frequente foi pneumonia hospitalar. Choque/parada cardíaca apresentou maior risco de óbito (OR = 5,76) em relação aos demais resultados adversos. Os maiores gastos com internações estiveram relacionados à sepse hospitalar. Os rastreadores de potencial resultado adverso apresentaram altas chances de óbito, mesmo com a introdução de variáveis como uso de terapia intensiva e realização de cirurgia. CONCLUSÕES: A alta frequência de resultados adversos em internações indica a necessidade de desenvolver estratégias de monitoramento e melhorias dirigidas para a segurança do paciente.
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Affiliation(s)
| | | | - Nair Navarro
- Escola Politécnica de Saúde Joaquim Venâncio, Brasil
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Using the patient safety indicators to detect potential safety events among US veterans with psychotic disorders: clinical and research implications. Int J Qual Health Care 2012; 24:321-9. [DOI: 10.1093/intqhc/mzs026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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