Validating administrative data for the detection of adverse events in older hospitalized patients

Abstract

Older hospitalized patients are at risk of experiencing adverse events including, but not limited to, hospital-acquired pressure ulcers, fall-related injuries, and adverse drug events. A significant challenge in monitoring and managing adverse events is lack of readily accessible information on their occurrence.PurposeThe objective of this retrospective cross-sectional study was to validate diagnostic codes for pressure ulcers, fall-related injuries, and adverse drug events found in routinely collected administrative hospitalization data.MethodsAll patients 65 years of age or older discharged between April 1, 2009 and March 31, 2011 from a provincial academic health sciences center in Canada were eligible for inclusion in the validation study. For each of the three types of adverse events, a random sample of 50 patients whose records were positive and 50 patients whose records were not positive for an adverse event was sought for review in the validation study (n=300 records in total). A structured health record review was performed independently by two health care providers with experience in geriatrics, both of whom were unaware of the patient’s status with respect to adverse event coding. A physician reviewed 40 records (20 reviewed by each health care provider) to establish interrater agreement.ResultsA total of 39 pressure ulcers, 56 fall-related injuries, and 69 adverse drug events were identified through health record review. Of these, 34 pressure ulcers, 54 fall-related injuries, and 47 adverse drug events were also identified in administrative data. Overall, the diagnostic codes for adverse events had a sensitivity and specificity exceeding 0.67 (95% confidence interval [CI]: 0.56–0.99) and 0.89 (95% CI: 0.72–0.99), respectively.ConclusionIt is feasible and valid to identify pressure ulcers, fall-related injuries, and adverse drug events in older hospitalized patients using routinely collected administrative hospitalization data. The information is relatively inexpensive and easy to access with no impact on clinical staff.

Monitoring adverse events in older hospitalized patients: A retrospective cross-sectional study using validated screening criteria with administrative data

“…[18] 2.4 Outcome measure Consistent with a surveillance approach, the primary outcome was an AE identified in administrative diagnostic data using previously validated screening criteria. [10,14] Adverse drug events were identified using the diagnostic codes developed by the Wisconsin Medical Injury Prevention Program (WMIPP). [10] Their screening criteria use a combination of the ICD (ICD-9-CM) diagnosis and external cause of injury codes applied to administrative data.…”

“…[11,13] Screening criteria or flags for specific AEs derived from diagnostic codes found in administrative data have been validated in the US using ICD-9-CM [10,12] and in Canada using ICD-10-CA. [14] Administrative data have been used more commonly for surveillance of adverse drug events, but have also been used to monitor other types of AEs. [6,[15][16][17] Although the use of screening criteria for patient harm has not been as widely adopted as the AHRQ PSIs, this approach has the potential to augment what is known from other sources such as incident reporting systems and offers an alternative for organizations that do not use the PSIs.…”

Prevalência De Eventos Adversos Entre Idosos Internados Em Unidade De Clínica Cirúrgica

“…O paciente idoso, no contexto hospitalar, representa um grupo altamente exposto à ocorrência de eventos adversos durante a prática assistencial, seja pela recuperação mais lenta, que prolonga o tempo de internação, seja pelo tipo de cuidado que necessita, seja, ainda, pela fragilidade pró-pria do ciclo de vida (2)(3)(4) . Entende-se evento adverso como um incidente decorrente da atenção à saúde, que resultou em algum tipo de dano ao paciente, podendo ser físico, social ou psicológico, o que inclui doença, lesão, sofrimento, incapacidade ou morte (5) .…”

“…Em estudos realizados em hospitais brasileiros, portugueses e canadenses, os eventos adversos mais descritos durante a hospitalização de idosos são infiltração, obstrução ou flebite em acesso venoso periférico, lesão por pressão, perda de sonda nasoenteral, queda e eventos relacionados à administração de medicamentos (2,4,7) . Revisão sistemática que avaliou a ocorrência de eventos adversos cirúrgicos evidenciou que os erros durante as atividades não cirúrgicas são mais frequentes do que os erros na técnica cirúrgica (8) .…”

“…Diante da grande parcela de idosos que utilizam os serviços de saúde, da susceptibilidade para a ocorrência de eventos adversos, dos altos custos relacionados aos modelos de atenção à saúde do idoso e às tentativas de minimizar os efeitos dos eventos adversos no paciente (1)(2)(3)(4)6) , este estudo justifica-se e poderá auxiliar na elaboração de estratégias mais eficazes para a sua prevenção durante a internação.…”