Diagnostic, surgical judgment, and systems issues leading to reoperation: mining administrative databases
Meghan M Dierks1, Zhen S Huang, Jeffrey J Siracuse
1Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
American Journal of Surgery
|March 16, 2010
Summary
Automated screening of clinical information systems (CIS) identified significantly more surgical adverse events requiring reoperation than traditional self-reporting methods. Reporting probability varied based on the event
Area of Science:
- Medical Informatics
- Surgical Safety
- Quality Improvement
Background:
- Underreporting of surgical adverse events hinders identification of quality and safety issues.
- Automated screening of clinical information systems (CIS) offers a potential solution to improve case capture.
- This study compares CIS screening to self-reporting for identifying unplanned reoperations.
Purpose of the Study:
- To compare the effectiveness of automated CIS screening versus self-reporting in identifying unplanned reoperations.
- To examine the relationship between the causality of an adverse event and its likelihood of being reported.
Main Methods:
- Automated screening of databases identified unplanned reoperations between 2005 and 2009.
- Identified cases were reviewed and classified by causality.
- Conditional probability analysis assessed reporting likelihood as a function of causality, comparing to self-reported cases.
Main Results:
- Automated CIS screening identified 1,010 unplanned reoperations out of 104,938 total operations.
- Only 23.6% of these cases were self-reported to departmental morbidity and mortality.
- The probability of reporting an adverse event varied significantly based on its underlying causality.
Conclusions:
- Automated CIS screening reveals substantial underreporting of adverse events requiring reoperation.
- Reporting bias exists, influenced by the causality of the adverse event.
- Implementing automated screening can enhance surgical safety and quality improvement initiatives.
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