No abstract

No abstract

No abstract

Taxonomy Development and Testing: The taxonomy was empirically developed on w600 AEs identified in a companion project that used the NCC MERP Index to describe severity. Our iterative process balanced parsimony with specificity describing both harm and non-harm events. We collapsed rare events into higher level sub-categorizations and added modifiers to provide further description. Safety and quality experts at 5 medical centers trained on use of the taxonomy on a conference call. To estimate reliability, collaborators independently reviewed 25 AE scenarios. Inter-rater reliability was assessed using the Fleiss kappa statistic for multiple raters.Results: The 50 most-cited articles (out of 165) and the taxonomies from 10 major patient safety organizations yielded 2 that included descriptions of harm: The Joint Commission's Patient Safety Event Taxonomy and the taxonomy from Adventist Health System. We used the latter as starting point, defining 7 categories and 51 subcategories. We added up to 3 "modifiers" per event (from a total of 46 modifiers available) to better describe events. Twenty-one distinct category-subcategory dyads were represented in the 25 test scenarios. There was complete agreement between reviewers in 20/25 scenarios. Inter-rater reliability was excellent for both overall-category scoring (k ¼ 81%) as well as for dyad scoring (k ¼ 79%).Conclusions: We developed a taxonomy of adverse events and non-harm events for the ED modified from an existing framework. Use of the tool with minimal training yielded excellent performance with high interrater reliability. We will perform additional reliability testing to cover all possible dyads and once validated, plan to use this taxonomy in further work related to adverse event detection in the ED.

infarction or cardiogenic shock for 12.7%. Documented goals of care discussion was available in 18 of 181 (10%) of transfer records. Our chart review revealed 22 (12%) instances of initial goals of care discussion taking place on admission to the hospital which resulted in the decision to transition to a comfort-based end-of-life care upon arrival. Care was transitioned to a comfort-based care within the first 24 hours for 88 (49%) of the patients.Conclusions: While transfer to a higher level of care is often necessary, the sought after care should be in line with the patient's goals. In this single center review of critically ill patients, it was striking that only 1 in 10 patients who were critically ill had a discussion about their goals of care addressed and documented prior to transfer. Although the decision to transfer a critically ill patient must often be made with in information, these results suggest an opportunity to improve on the current state. The 12% of patients transitioned to comfort-based care upon arrival to our hospital suggests an opportunity to improve patient care while also decreasing unnecessary transfer. Addressing goals of care along with aggressive medical interventions is important to providing a therapy consistent with our patients' goals and avoiding costly and invasive treatments that do not align with their goals of care.