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Updated: Sep 9, 2025

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Validity of Novel Classification of Patient Safety and Patient-Centered Outcomes
Alex S Luke1, Anastasia Jermihov1, Leanna Wynne2
1Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA.
Objectives:
To validate and assess the interrater agreement on a novel classification system for reporting adverse events.
Methods:
A cross-sectional review of adverse events recorded from 2019 to 2023 of 211 patient cases within the Department of Otolaryngology-Head and Neck Surgery at a tertiary care center. Three raters (one attending and two resident physicians) were recruited to classify these cases according to two classification systems, Clavien Dindo Classification (CDC) and the new classification system, Quality Improvement Classification System (QICS).
Results:
The three raters graded 211 patient cases using CDC and QICS, and the interrater reliability was determined and reported as Cronbach's Alpha and Fleiss κ: CDC (α = 0.902, κ = 0.578) and QICS (α = 0.963, κ = 0.799). A strong interrater concordance was observed for both classification systems.
Conclusion:
The novel QICS method for categorizing adverse events has high interrater reliability and is comparable to the well-validated CDC classification. This novel system allows expanded classification to include outpatient settings and is well-suited to otolaryngology.
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