Can medical record reviewers reliably identify errors and adverse events in the ED?

Klasco, Richard; Wolfe, Richard E.; Lee, Terrance; Anderson, Philip D.; Jacobson, Lee; Solano, Joshua J.; Edlow, Jonathan A.; Grossman, Shamai A.

doi:10.1016/j.ajem.2016.03.001

Cited by 9 publications

(4 citation statements)

References 25 publications

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“…Patient safety events occurred in 6.1% of those patients who were flagged as having QAI. When compared with several other studies that have been conducted in the ED, 9–15,17–22 we found that patients who were flagged as having QAI had higher Charlson comorbidity scores, higher acuity triage scores, and higher likelihood of ICU admission or in-hospital death, indicating that sicker patients and those with more serious conditions were more likely to be exposed to a potential occurrence of PSEs. In addition, we found that the group of diagnoses at risk for PSEs occurrence was musculoskeletal and connective tissue diseases, genitourinary diseases, and symptoms, signs, and abnormal clinical and laboratory findings not classified elsewhere may also have contributed to increasing the risk of PSEs.…”

Section: Discussionmentioning

confidence: 52%

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Analysis of Risk Factors for Patient Safety Events Occurring in the Emergency Department

Alsabri

Boudi²,

Zoubeidi

et al. 2020

J Patient Saf

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The aim of the study was to describe and analyze the risk factors associated with patient safety events (PSEs), defined as adverse events (AEs), preventable AEs (PAEs), and near-miss events (NMEs), in the emergency department (ED). Methods:It was a retrospective cohort study using ED patients' data retrieved from January 2010 to December 2016. Quality assurance issues (QAIs) used as triggers included the following: issues during procedural sedation, death within 24 hours of admission, patients' and physicians' complaints, returns to the ED within 72 hours, and transfers to an intensive care unit within 24 hours.Results: Of 383,586 ED visits, 6519 (1.7%) QAIs were reported with a PSEs incidence of 6.1%. Among the 397 PSEs, 258 were AEs including 82 PAEs, and 139 NMEs. During the 7-year period, we observed a fourfold increase in NMEs, and despite a decrease in the rate of AEs with the highest (3.1%) and lowest (0.8%) incidence in 2011 and 2016, respectively, the incidence of PAEs events remained relatively constant. Unadjusted analysis showed that ED waiting time, boarding time, ED length of stay (LOS), ED disposition, as well as diagnostic and QAIs were significantly related to PSEs (P < 0.05). Multivariable analysis showed that the type of QAIs and diagnostic were associated with PSEs (P < 0.001). Type of QAIs was a risk factor for AEs and PAEs occurrence and factors involved in NMEs were type of QAIs (P = 0.02) and ED LOS (P < 0.001). "The odds of a PSE occurring increased by 0.2% for each additional minute increase in the ED waiting time, by 5.2% for each additional boarding hour, and by 4.5% for each ED LOS hour." Conclusions: This study showed several potential risk factors for PSEs, especially ED LOS, type of QAIs, and diagnostic. Systematic interventions might have more impact on risk of PSE.

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Section: Discussionmentioning

confidence: 52%

“…During bimonthly meetings, the committee came up with a consensus decision on the occurrence of an error or AE. In a prior publication, Klasco et al 17 reported this method of identifying errors and AEs as accurate and well grounded.…”

Section: Data Collection and Processingmentioning

confidence: 99%

Analysis of Risk Factors for Patient Safety Events Occurring in the Emergency Department

Alsabri

Boudi²,

Zoubeidi

et al. 2020

J Patient Saf

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“…Studies that have assessed error have often failed to use providers with actual expertise in the standard of care of the particular discipline. 9 Reviews by providers unfamiliar with a given specialty or local conditions may add to the subjectivity of error assignment. The lack of scientific methodology in error assignment has been identified as a concern as early as 1996 but has rarely been considered even in the studies that supported the opinions in the IOM report.…”

Section: Introductionmentioning

confidence: 99%

The Ethics of Error in Medicine

Grossman

Gurley

Wolfe

2020

Rambam Maimonides Med J

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The practice of medicine forces medical practitioners to make difficult and challenging choices on a daily basis. On the one hand we are obligated to cure with every resource available, while on the other hand we put the patient at risk because our treatments are flawed. To understand the ethics of error in medicine, its moral value, and the effects, error must first be defined. However, definition of error remains elusive, and its incidence has been extraordinarily difficult to quantify. Yet, a health care system that acknowledges error as a consequence of normative ethical practice must create systems to minimize error. Error reduction, in turn, should attempt to decrease patient harm and improve the entire health care system. We discuss a number of ethical and moral considerations that arise from practicing medicine despite anticipated error.

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“…1 This methodology facilitates epidemiological investigations, quality assessments, education, and clinical research. [2][3][4] Retrospective chart reviews are used in 15% to 25% of scientific articles in emergency medical journals. 5,6 Additionally, .90% of PICUs use this approach to inform their morbidity and mortality conferences.…”

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confidence: 99%

Structured Chart Review: Assessment of a Structured Chart Review Methodology

Siems

Banks

Holubkov

et al. 2020

Hospital Pediatrics

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and U01HD049934. UG1HD083171, UG1HD083166, and UG1HD083170. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funded by the National Institutes of Health (NIH). POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. Drs Siems, Meert, and Pollack conceptualized and designed the study, drafted the initial manuscript, participated in data collection, chart reviews, and the data analysis, and reviewed and revised the manuscript; Mr Banks conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content; Drs Beyda, Berg, Burd, Carcillo, Dean, Hall, Newth, Notterman, Sapru, Wessel, and Zuppa helped design the study, assisted with data collection, reviewed the data analysis, and reviewed and revised the manuscript; Drs Bauerfeld, Bulut, Gradidge, McQuillen, Mourani, Priestley, and Yates helped with data collection, data analysis, and revisions of the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Can medical record reviewers reliably identify errors and adverse events in the ED?

Cited by 9 publications

References 25 publications

Analysis of Risk Factors for Patient Safety Events Occurring in the Emergency Department

Analysis of Risk Factors for Patient Safety Events Occurring in the Emergency Department

The Ethics of Error in Medicine

Structured Chart Review: Assessment of a Structured Chart Review Methodology

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