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Use of generic quality improvement chart review to recognize nosocomial infection
1University of Alberta Hospitals, Edmonton, Canada.
Background:
Generic medical quality improvement concurrent chart review for adverse patient occurrences was introduced into our hospital. To determine whether this program could be used to augment the surveillance activities of the infection control program, an evaluation of this review was carried out and it was compared with existing surveillance methods.
Methods:
Analysts were provided with Centers for Disease Control definitions of site infections and were trained in identification. During a 6-month period (period 1) infections in this manner documented were reviewed by infection control program to confirm nosocomial infection as a measure of specificity. Data were also compared with infection control surveillance data when the two programs overlapped (nosocomial bloodstream infections and surgical wound infections) as a check on the sensitivity of the data generated in the medical quality improvement process. A second 6-month review of data (period 2), starting 3 months after completion of period 1, was carried out; this review was limited to areas of overlap and designed to determine whether changes in data occurred with experience.
Results:
In period 1, 72% (109/152) of infections detected by chart review were confirmed by infection control methods, and 51% (26/51) of infections detected by the infection control program were also detected by chart review. During period 2 the values were 73% (52/71) for confirmed infections and 61% (43/70) for detected infections. There was no statistical difference between periods 1 and 2. In the two periods 25 bacteremic infections went undetected by chart surveyors.
Conclusion:
We conclude that this chart surveillance has only moderate sensitivity and specificity compared with our infection control surveillance methods. Improvements were not demonstrated with experience.
Insights
Medical quality improvement chart review showed moderate accuracy in detecting hospital-acquired infections. This method did not significantly improve over time and missed some bacteremic infections.
Area of Science:
- Healthcare Quality
- Infection Control
- Medical Surveillance
Background:
- A hospital implemented a generic medical quality improvement concurrent chart review for adverse patient events.
- The study evaluated this program's potential to enhance infection control surveillance activities.
- Comparison was made against existing infection control surveillance methods.
Purpose of the Study:
- To assess the sensitivity and specificity of chart review for detecting nosocomial infections.
- To compare chart review data with established infection control surveillance data.
- To determine if experience improved the accuracy of chart review over time.
Main Methods:
- Analysts used Centers for Disease Control definitions for site infections.
- Infection control confirmed infections identified via chart review (period 1).
- Data were compared with infection control surveillance during overlapping periods and re-evaluated after 3 months (period 2).
Main Results:
- In period 1, chart review confirmed 72% of infections and detected 51% of infections found by infection control.
- In period 2, confirmation was 73% and detection was 61%, with no significant change.
- Across both periods, 25 bacteremic infections were missed by chart review.
Conclusions:
- Concurrent chart review demonstrates moderate sensitivity and specificity for hospital-acquired infection surveillance.
- The chart review process did not show improvement in accuracy with increased experience.
- This method may not fully replace or augment traditional infection control surveillance effectively.