Departments of Surgery and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Departments of Community Health Sciences and Medicine, University of Calgary, W21C Research and Innovation Centre, Calgary, Alberta, Canada.
BMJ Qual Saf. 2019 Apr;28(4):310-316. doi: 10.1136/bmjqs-2018-008090. Epub 2019 Jan 18.
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.
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.
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).
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.
不良事件（AE）的报告仍然是胸外科质量改进的重要组成部分。手术中报告 AE 的最佳方法尚不清楚。我们开发了一种使用带有嵌入式数据收集字段的电子出院小结的 AE 报告系统，该系统指定了手术程序和并发症。这些数据每天自动传输到基于网络的报告系统。
我们通过将程序和并发症记录捕获的完整性与编码的出院数据（管理数据）进行比较，并在两个时间间隔与图表审核的标准进行比较，来确定这种电子实时数据采集系统（ERD）的准确性和可持续性。在启动时（Ti）和 1 年后（T1yr）连续两个月进行的所有手术程序都由一名客观训练有素的摘要员进行审核。第二名摘要员审核了 10％的图表。
ERD 在 Ti 时捕获了 71/72（99％）的图表，在 T1yr 时捕获了 56/65（86％）的图表。比较 ERD 和图表审核之间的并发症存在/不存在情况，Ti 时 ERD 具有高灵敏度和特异性、95.5％的阳性预测值（PPV）、93.9％的阴性预测值（NPV）和 0.872 的kappa 值（95％CI 0.750 至 0.994），T1yr 时 ERD 的灵敏度、特异性、PPV 和 NPV 均为 100％，kappa 值为 1.0（95％CI 1.0）。Ti 时，比较管理数据和图表审核之间的并发症存在/不存在情况，灵敏度低，特异性高，kappa 值为 0.471（95％CI 0.256 至 0.686），T1yr 时，灵敏度低，特异性高为 85％，kappa 值为 0.479（95％CI 0.245 至 0.714）。
我们发现 ERD 可以提供准确的胸外科实时 AE 报告，比以前的报告方法具有优势，并且是开发 AE 报告系统的外科临床团队的替代系统。
