Center for Organization, Leadership, Management Research, a VA Center of Excellence, VA Boston Healthcare System, Boston, Massachusetts 02130, USA.
J Patient Saf. 2011 Mar;7(1):45-59. doi: 10.1097/PTS.0b013e31820d164b.
The objective of this study is to evaluate the performance of 5 triggers to detect adverse events (AEs) associated with outpatient surgery. Triggers use surveillance algorithms derived from clinical logic to flag cases where AEs have most likely occurred. Current efforts to detect AEs have focused primarily on the inpatient setting, despite the increase in outpatient surgery in all health care settings.
Using trigger logic, we retrospectively evaluated data from 3 large health care systems' electronic medical records. Patients were eligible for inclusion if they had an outpatient (same-day) surgery in 2007 and at least 1 clinical note in the 6 months after the surgery. Two nurse abstractors reviewed a sample of trigger-flagged cases from each health care system. After reaching interrater reliability targets (κ > 0.60), we calculated the positive predictive value (PPV) of each trigger and the confidence interval of the estimate.
The surgical triggers flagged between 1% and 22% of the outpatient surgery cases, with a wide range in PPVs (6.0%-62.0%). The pulmonary embolism and deep vein thrombosis and emergency department triggers had the lowest proportion of flagged cases along with the highest PPVs, showing the most promise for screening cases with a high probability of AE occurrence.
Triggers may be useful in identifying a narrow set of surgeries for further review to determine if a surgical AE occurred, complementing existing tools and initiatives used to detect AEs. Improved detection of AEs in outpatient surgery should help target potential areas for quality improvement.
本研究旨在评估 5 种触发器在检测与门诊手术相关的不良事件（AE）中的性能。触发器使用源自临床逻辑的监测算法来标记最有可能发生 AE 的病例。目前，检测 AE 的工作主要集中在住院环境中，尽管所有医疗保健环境中的门诊手术都有所增加。
使用触发器逻辑，我们回顾性地评估了来自 3 个大型医疗保健系统电子病历的数据。如果患者在 2007 年进行了门诊（当天）手术，并且在手术后的 6 个月内至少有 1 次临床记录，那么他们就有资格被纳入研究。两名护士摘录员审查了每个医疗保健系统中标记为触发器的病例样本。达到了组内一致性目标（κ＞0.60）后，我们计算了每个触发器的阳性预测值（PPV）及其估计值的置信区间。
手术触发器标记了门诊手术病例的 1%至 22%，PPV 差异很大（6.0%-62.0%）。肺栓塞和深静脉血栓形成以及急诊触发器标记的病例比例最低，PPV 最高，这表明它们在筛选 AE 发生可能性较高的病例方面最有希望。
触发器可用于识别一小部分手术进行进一步审查，以确定是否发生了手术 AE，从而补充现有的用于检测 AE 的工具和计划。提高门诊手术中 AE 的检测率应有助于确定潜在的质量改进领域。
