Improving the identification of Postoperative Wound Dehiscence missed by the Patient Safety Indicator algorithm - 16/05/13
, Marisa Cevasco, M.D., M.P.H. d, e, Hillary Mull, Ph.D., M.P.P. f, g, Marlena Shin, J.D., M.P.H. f, Kamal Itani, M.D. d, g, h, Amy K. Rosen, Ph.D. b, f, gAbstract |
Background |
The Patient Safety Indicator (PSI) Postoperative Wound Dehiscence (PWD) is an administrative data-based algorithm that flags cases using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 54.61 (abdominal wall disruption reclosure). We examined how often PWD missed events and explored ways to improve event identification.
Methods |
We selected 125 high-risk unflagged cases based on predicted probability and the presence of clinically relevant codes. We determined the false-negative proportion and associated reasons through chart review and calculated likelihood ratios of associated codes.
Results |
Thirty-two percent of cases were false negatives, 60% of which lacked any abdominal wall repair codes. All individual codes had low likelihood ratios; the combination of diagnosis code 998.3x (operative wound disruption) and particular abdominal wall repair procedure codes occurred exclusively in false-negative cases (representing 24% of false-negative cases).
Conclusions |
Among high-risk cases, the PWD algorithm frequently missed events. Coder training to clarify assignment of abdominal wall repair codes, plus adding specific code combinations to the algorithm, would improve event identification.
Le texte complet de cet article est disponible en PDF.Keywords : Postoperative wound dehiscence, Adverse events, Quality of care, Patient safety, Quality indicators
Plan
| This study was funded by the US Department of Veterans Affairs Health Services Research and Development Service grant number SDR 07-002. The funding agency had no involvement in: study design, data collection, interpretation or analysis, manuscript writing or the decision to submit this work for publication. |
Vol 205 - N° 6
P. 674-680 - juin 2013 Retour au numéro
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