N. Fox1, R. Willcutt1, A. Elberfeld1, J. Porter1, A. Mazzarelli1 1Cooper University Hospital,Trauma,Camden, NJ, USA
Introduction: The Agency for Health Care Research and Quality (AHRQ) developed patient safety indicators (PSIs) to identify events with a high likelihood of representing medical error. They are increasingly used by health systems as quality measures that impact public profiling and compensation. The purpose of this study was to validate PSIs attributed to trauma surgeons and compare validated PSIs to our performance improvement (PI) and morbidity and mortality (M&M) data. We hypothesized that PSIs are not an indicator of quality of care in trauma.
Methods: PSI’s attributed to trauma surgeons (n=9) at our institution were reviewed (Jan-Dec 2015). A documentation improvement team performed an initial review of all PSIs to ensure they were correctly identified and met inclusion and exclusion criteria (valid). “Valid” PSIs were distributed to the trauma division for review and compared to PI and M&M data.
Results:2,779 patients were admitted during the study period. 48 PSIs were identified (17.2 per 1000 cases). 23 were false positives yielding a positive predictive value of 52% (95% CI 37 to 66%). Contributing factors to false positive PSIs were coding error (78%), present on admission status (17%) and documentation error (5%). Valid PSIs (n=25) were further analyzed. The most common were post-op PE/DVT (n=10), failure to rescue (n=6) and accidental puncture/laceration (n=3). 60% of patients with a post-op PE/DVT were started on appropriate chemoprophylaxis on admission and 40% had significant intracranial hemorrhage (not candidates for immediate chemoprophylaxis); therefore all were determined to be non-preventable through trauma PI. All deaths considered failure to rescue were classified as expected mortalities during M&M review. All cases classified as accidental puncture/laceration (6% of valid PSIs) were considered accurate and represented the only opportunity for improvement.
Conclusion:Overall, PSIs have low validity and do not reflect quality of care in trauma. Trauma PI and M&M data along with chart review should be used to identify true opportunities for improvement in care.