Assessment of postoperative pulmonary embolism as a measure of patient care

Hospitals presenting voluntarily for accreditation survey during 1993 submitted data on pulmonary embolism to the Australian Council on Health Care Standard (ACHS) Care Evaluation Program (CEP) as a part of their medical quality activities. The data were stratified by hospital type and bed-size, and compared to the provisional threshold of 1%. The mean duration of data collection was 24 weeks (range 8-74 weeks). Of hospitals with bed-size 1-50, 77% observed a zero pulmonary embolism rate. Hospitals with zero and non-zero pulmonary embolism rates were significantly different with respect to bed-size (P = 0.001). The rarity of pulmonary embolism and lack of prospective continuous monitoring poses considerable problems in interpretation of aggregate rates. Hospitals with a high patient throughout should continuously monitor their pulmonary embolism data to achieve a large denominator. For smaller hospitals with a low performance of major operations, collection of data on this clinical indicator is unlikely to be useful as a measure of quality of care.