Articles: hospitals.
-
Multicenter Study
How valid is the AHRQ Patient Safety Indicator "postoperative respiratory failure"?
The Agency for Healthcare Research and Quality Patient Safety Indicator postoperative respiratory failure (PRF) uses administrative data to screen for potentially preventable respiratory failure after elective surgery based on a respiratory failure diagnosis or an intubation or ventilation procedure code. Data on PRF accuracy in identifying true events is scant; a recent study using University HealthSystem Consortium data found a positive predictive value (PPV) of 83%. We examined the indicator's PPV in the Veterans Health Administration. ⋯ Based on our and University HealthSystem Consortium's findings, PRF should continue to be used as a screen for potential patient-safety events. Its PPV could be substantially improved in the Veterans Health Administration through introduction of an admission status code. Many PRF-identified cases appeared to be at high risk, based on patient and procedure-related factors. The degree to which such cases are truly preventable events requires additional assessment.
-
The Agency for Healthcare Research and Quality (AHRQ) recently designed the Patient Safety Indicators (PSIs) to detect potential safety-related adverse events. The National Quality Forum has endorsed several of these ICD-9-CM-based indicators as quality-of-care measures. We examined the positive predictive value (PPV) of 3 surgical PSIs: postoperative pulmonary embolus and deep vein thrombosis (pPE/DVT), iatrogenic pneumothorax (iPTX), and accidental puncture and laceration (APL). ⋯ Until coding revisions are implemented, these PSIs, especially pPE/DVT, should be used primarily for screening and case-finding. Their utility for public reporting and pay-for-performance needs to be reassessed.
-
Multicenter Study
Validity of the AHRQ Patient Safety Indicator "central venous catheter-related bloodstream infections".
"Central venous catheter-related bloodstream infections" (CR-BSIs) is one of the patient safety indicators (PSI 7) developed by the Agency for Healthcare Research and Quality (AHRQ) to screen for potential safety events. We sought to investigate the validity of this PSI using the medical record as the gold standard. ⋯ PSI 7 has relatively poor predictive ability for identifying true events. Coding-related issues were the main reason for the low PPV. Implementing POA codes and using more specific ICD-9-CM codes would improve its validity. As it currently stands, PSI 7 should not be used as a pay-for-performance measure, but should be limited to use in internal quality improvement efforts.
-
Multicenter Study
Positive predictive value of the AHRQ Patient Safety Indicator "postoperative wound dehiscence".
The Agency for Healthcare Research and Quality patient safety indicator (PSI) 14, or "postoperative wound dehiscence," is 1 of 4 PSIs recently adopted by the Centers for Medicare & Medicaid Services to compare quality and safety across hospitals. We determined how well it identifies true cases of postoperative wound dehiscence by examining its positive predictive value (PPV). ⋯ PSI 14 has relatively good predictive ability to identify true cases of postoperative wound dehiscence. It has the highest PPV among all PSIs evaluated within the Veterans Health Administration system. Inaccurate coding was the reason for false positives. Providing additional training to medical coders could potentially improve the PPV of this indicator. At present, this PSI is a promising measure for both quality improvement and performance measurement; however, its use in pay-for-performance efforts seems premature.
-
Multicenter Study Comparative Study
Point prevalence of patients fulfilling MET criteria in ten MET equipped hospitals. The methodology of the RESCUE study.
The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. ⋯ In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.