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Logo of qualsafetyQuality and Safety in Health CareCurrent TOCInstructions for authors
Qual Saf Health Care. Oct 2005; 14(5): 378–382.
PMCID: PMC1744069

Effectiveness of routine reporting to identify minor and serious adverse outcomes in surgical patients

Abstract

Objective: To assess the effectiveness of routine reporting to identify surgical adverse outcomes in comparison with retrospective medical record review.

Design: Independent assessment of two methods applied to one sample. Surgeons and surgical residents routinely reported all adverse outcomes for patients in their care during admission. A trained research assistant, blinded to the surgeons' reporting data, retrospectively reviewed the medical records of selected patients and registered all adverse outcomes identified from paper or electronic patient records.

Setting: Dutch university hospital.

Study sample: A 5% sample of patients (N = 150) discharged in 2002 was taken; oversampling of patients undergoing reoperations, sick patients (ASA [gt-or-equal, slanted]3), and those undergoing technically complex surgery was done to increase the yield of adverse outcomes.

Main outcome measures: The number of adverse outcomes identified by each method was compared with the total number identified by either method. This was done both for all adverse outcomes and for serious adverse outcomes.

Results: Routine reporting identified fewer adverse outcomes than medical record review (62.5% v 78.2%). Complete agreement was achieved in only 40.7% of adverse outcomes. Routine reporting identified slightly more serious adverse outcomes (84.8% v 79.5% of the total), but this difference was not statistically significant. Extrapolating these results to the total number of admissions in 2002, routine reporting underestimated the annual adverse outcome incidence by 1.8% (increasing from 14.5% to 16.3%) and the incidence of serious adverse outcomes by 0.3% (increasing from 6.9% to 7.2%).

Conclusions: Neither method identified all adverse outcomes. Routine reporting underestimated the incidence of minor events but was as accurate as record review in identifying serious adverse outcomes.

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Selected References

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  • Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991 Feb 7;324(6):370–376. [PubMed]
  • Gawande AA, Thomas EJ, Zinner MJ, Brennan TA. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery. 1999 Jul;126(1):66–75. [PubMed]
  • Kable AK, Gibberd RW, Spigelman AD. Adverse events in surgical patients in Australia. Int J Qual Health Care. 2002 Aug;14(4):269–276. [PubMed]
  • Davis Peter, Lay-Yee Roy, Scott Alastair, Briant Robin, Schug Stephan. Acknowledgement of "no fault" medical injury: review of patients' hospital records in New Zealand. BMJ. 2003 Jan 11;326(7380):79–80. [PMC free article] [PubMed]
  • Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 2001 Jul 25;286(4):415–420. [PubMed]
  • Marang-van de Mheen PJ, Kievit J. Geautomatiseerde registratie van complicaties door heelkundige afdelingen in Nederland: huidige stand van zaken. Ned Tijdschr Geneeskd. 2003 Jun 28;147(26):1273–1277. [PubMed]
  • Marang-van de Mheen PJ, Mertens BJA, van Houwelingen HC, Kievit J. Surgery groups differed in adverse outcome probabilities and can be used to adjust hospital comparisons. J Clin Epidemiol. 2005 Jan;58(1):56–62. [PubMed]
  • O'Neil AC, Petersen LA, Cook EF, Bates DW, Lee TH, Brennan TA. Physician reporting compared with medical-record review to identify adverse medical events. Ann Intern Med. 1993 Sep 1;119(5):370–376. [PubMed]
  • Wolff AM, Bourke J, Campbell IA, Leembruggen DW. Detecting and reducing hospital adverse events: outcomes of the Wimmera clinical risk management program. Med J Aust. 2001 Jun 18;174(12):621–625. [PubMed]
  • Firth-Cozens J. Barriers to incident reporting. Qual Saf Health Care. 2002 Mar;11(1):7–7. [PMC free article] [PubMed]
  • Michel Philippe, Quenon Jean Luc, de Sarasqueta Anne Marie, Scemama Olivier. Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals. BMJ. 2004 Jan 24;328(7433):199–199. [PMC free article] [PubMed]

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