The Korea National Patient Safety Incidents Inquiry Survey: Feasibility of Medical Record Review for Detecting Adverse Events in Regional Public Hospitals

Abstract

Objectives:We aimed to examine the Korea National Patient Safety Incidents Inquiry conducted in the Republic of Korea; specifically, we assessed the validity of screening criteria, interreviewer reliability, quality of medical records, and the time required for reviewing medical records.Methods: A 3-stage retrospective medical record review was performed.The sensitivity and positive predictive value of the screening criteria for the adverse events were calculated, and interreviewer reliability was verified using the overall agreement rate and κ value. In addition, the results of medical record quality assessment and time required for review were analyzed.Results: There were a total of 4159 patients (55.5%) with at least 1 of the 41 screening criteria. In stage 1, the overall percent of agreement was 81.9% when all negatives from the 2 reviewers were included, and the κ value was 0.64 (95% confidence interval [CI], 0.61-0.66). In stage 2, 84.6% of cases were a perfect match, and 87.4% were a partial match. The κ values were 0.159 (95% CI, 0.12-0.20) and 0.389 (95% CI, 0.35-0.43), respectively. The mean quality assessment scores were 3.18 of 4 points in stage 1 and 3.05 of 4 points in stage 2. In stage 1, it took an average of 13.02 minutes to asses each patient file; in stage 2, it took an average of 5.06 minutes. Conclusions:To increase the feasibility of medical record review for detecting adverse events, it is important not only to improve the reliability between reviewers but also to monitor the quality of medical records and the time required for review.

Development of the Korean Patient Safety Incidents Code Classification System

“…The classification system developed in this study is consistent with that of the Korea National Patient Safety Incidents Inquiry Survey using the medical record review. 7 The accuracy of the patient safety incident and POA codes may be evaluated through codes related to patient safety incidents in the diagnosis codes of patients identified in the National Patient Safety Incidents Inquiry Survey, along with determining whether the POA code is "N." 6 The scarcity of diagnosis-related patient safety incident codes is one major limitation of the developed patient safety incident code classification system. Among the 4509 patient safety incident codes, only 2 codes related to diagnosis were grouped under "nonadministration of surgical and medical care," which were not enough to cover all of the various diagnosis-related patient safety incidents.…”

“…In particular, to ensure the accuracy of patient safety incidents and POA codes, it is important to match the classification system with investigations using other patient safety monitoring methods. The classification system developed in this study is consistent with that of the Korea National Patient Safety Incidents Inquiry Survey using the medical record review 7 . The accuracy of the patient safety incident and POA codes may be evaluated through codes related to patient safety incidents in the diagnosis codes of patients identified in the National Patient Safety Incidents Inquiry Survey, along with determining whether the POA code is “N.” 6 …”

“…The researchers classified the Korean patient safety incident codes identified through the Delphi review based on the categories used in previous studies 7,18,19,24–27 . The codes were classified into the most appropriate category based on the categorical name, description, and reviewer comments.…”

“…The researchers classified the Korean patient safety incident codes identified through the Delphi review based on the categories used in previous studies. 7,18,19,[24][25][26][27] The codes were classified into the most appropriate category based on the categorical name, description, and reviewer comments. For instance, if the categorical name, description, or comments included the key word, "druginduced," the code was classified as a drug-related complication.…”

“…However, it is not easy to obtain a comprehensive understanding of patient safety level. Thus, various methodologies such as analyses of medical malpractice litigation, 3 reporting and learning systems for patient safety incidents, 4 assessments of administrative data, 5,6 and review of medical records 7 have been used. Each method has its own strengths and weaknesses, and their interpretations vary depending on the type of patient safety incident 8 .…”