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Evaluation of an electronic health record structured discharge summary to provide real time adverse event reporting in thoracic surgery
  1. Andrew J Graham1,
  2. Wrechelle Ocampo2,
  3. Danielle A Southern3,
  4. Anthony Falvi4,
  5. Dina Sotiropoulos4,
  6. Bruce Wang5,
  7. Kevin Lonergan6,
  8. Biraboneye Vito7,
  9. William A Ghali8,
  10. Sean Daniel Patrick McFadden1
  1. 1 Departments of Surgery and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  2. 2 Departments of Community Health Sciences and Medicine, University of Calgary, W21C Research and Innovation Centre, Calgary, Alberta, Canada
  3. 3 Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  4. 4 Department of Thoracic Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
  5. 5 IT, Alberta Health Services, Calgary, Alberta, Canada
  6. 6 Analytics, Alberta Health Services, Calgary, Alberta, Canada
  7. 7 Clinical Informatics Services, Alberta Health Services, Calgary, Alberta, Canada
  8. 8 Departments of Community Health Sciences and Medicine, and the Calgary Institute for Population and Public Health, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Andrew J Graham, Departments of Surgery and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada; andrew.graham{at}albertahealthservices.ca

Abstract

Background The reporting of adverse events (AE) remains an important part of quality improvement in thoracic surgery. The best methodology for AE reporting in surgery is unclear. An AE reporting system using an electronic discharge summary with embedded data collection fields, specifying surgical procedure and complications, was developed. The data are automatically transferred daily to a web-based reporting system.

Methods We determined the accuracy and sustainability of this electronic real time data collection system (ERD) by comparing the completeness of record capture on procedures and complications with coded discharge data (administrative data), and with the standard of chart audit at two intervals. All surgical procedures performed for 2 consecutive months at initiation (Ti) and 1 year later (T1yr) were audited by an objective trained abstractor. A second abstractor audited 10% of the charts.

Results The ERD captured 71/72 (99%) of charts at Ti and 56/65 (86%) at T1yr. Comparing the presence/absence of complications between ERD and chart audit demonstrated at Ti a high sensitivity and specificity, positive predictive value (PPV) of 95.5%, negative predictive value (NPV) of 93.9% with a kappa of 0.872 (95% CI 0.750 to 0.994), and at T1yr a sensitivity, specificity, PPV and NPV of 100% with a kappa of 1.0 (95% CI 1.0). Comparing the presence/absence of complications between administrative data and chart audit at Ti demonstrated a low sensitivity, high specificity and a kappa of 0.471 (95% CI 0.256 to 0.686), and at T1yr a low sensitivity, high specificity of 85% and a kappa of 0.479 (95% CI 0.245 to 0.714).

Conclusions We found that the ERD can provide accurate real time AE reporting in thoracic surgery, has advantages over previous reporting methodologies and is an alternative system for surgical clinical teams developing AE reporting systems.

  • adverse events
  • surgery
  • patient safety
  • quality improvement
  • quality improvement methodologies

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Footnotes

  • Collaborators L Graham; DJ Hunter.

  • Contributors AJG: design, analysis and interpretation of data, and drafting of the manuscript. WO: acquisition of data, revision of manuscript. DAS: analysis and interpretation of data, revision of manuscript. AF and DS: data acquisition. BW: design of data reporting system. KL: design of data reporting system, critical revision of manuscript. WAG: design and critical revision of manuscript. SDPM: design, interpretation of data and critical revision of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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