Performance of hospital administrative data for detection of sepsis in Australia: The sepsis coding and documentation (SECOND) study

Duke, Graeme; Bishara, Maria; Hirth, Steve; Lim, Lyn-Li; Worth, Leon J.

doi:10.1177/18333583221107713

Cited by 3 publications

(7 citation statements)

References 24 publications

(60 reference statements)

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“…Notably, while 35% of patients admitted direct to the ICU from ED were identified by trained research coordinators as meeting the pre‐defined survey inclusion criteria for sepsis, in less than one‐third of those patients the ICU admission APACHE III diagnostic code extracted from the patient's medical record was sepsis or sepsis with shock. This apparent underestimation of community‐onset sepsis case detection in hospital administrative databases, as compared with clinical review of medical records, is consistent with previous reports 26 …”

Section: Discussionsupporting

confidence: 91%

Early sepsis in Australia and New Zealand: A point‐prevalence study of haemodynamic resuscitation practices

Peake

Delaney

Finnis

et al. 2023

Emerg Medicine Australasia

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ObjectiveOptimal resuscitation of sepsis‐induced hypotension is uncertain, particularly the role of restrictive fluid strategies, leading to variability in usual practice. The objective of this study is to understand resuscitation practices in patients presenting to ED with early sepsis.MethodsDesign, participants and setting: Prospective, observational, multicentre, single‐day, point‐prevalence study enrolling adult patients present in 51 Australian and New Zealand ICUs at 10.00 hours, 8 June 2021. Main outcome measures: Site‐level data on sepsis policies and patient‐level demographic data, presence of sepsis and fluid and vasopressor administration in the first 24 h post‐ED presentation.ResultsA total of 722 patients were enrolled. ED was the ICU admission source for 222 of 722 patients (31.2%) and 78 of 222 patients (35%) met the criteria for sepsis within 24 h of ED presentation. Median age of the sepsis cohort was 61 (48–72) years, 58% were male and respiratory infection was the commonest cause (53.8%). The sepsis cohort had a higher severity of illness than the non‐sepsis cohort (144/222 patients) and chronic immunocompromise was more common. Of 78 sepsis patients, 55 (71%) received ≥1 fluid boluses with 500 and 1000 mL boluses equally common (both 49%). In the first 24 h, 2335 (1409–3125) mL (25.3 [13.2–42.9] mL/kg) was administered. Vasopressors were administered in 53 of 78 patients (68%) and for 25 patients (47%) administration was peripheral.ConclusionsICU patients presenting to the ED with sepsis receive less fluids than current international recommendations and peripheral vasopressor administration is common. This finding supports the conduct of clinical trials evaluating optimal fluid dose and vasopressor timing for early sepsis‐induced hypotension.

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Section: Discussionsupporting

confidence: 91%

Early sepsis in Australia and New Zealand: A point‐prevalence study of haemodynamic resuscitation practices

Peake

Delaney

Finnis

et al. 2023

Emerg Medicine Australasia

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“…Kilkenny et al (2022) reported variation in the reporting of comorbidities of stroke in administrative data suggesting the need to improve clinical documentation. Duke et al (2022) examined coding-based definitions for sepsis and identified significant differences in sepsis classification in administrative data (e.g. use of explicit ICD10-AM diagnosis codes was poorly predictive of sepsis, with low sensitivity).…”

Section: Virtual Special Issue On CDImentioning

confidence: 99%

“…The significance of clinical coding as impacted by CDI has been alluded to in a number of articles in the VSI collection that describe issues experienced by specific clinical programmes where information was not available in a form that supported the programme. Strategies to address the limitations of administrative coded data and lack of specificity in support of CDI have been proposed by Duke et al (2022), Payton et al (2023) and Sierla and Dylke (2023). In their editorial on the emergence of health information in aged care, Loggie and Davis (2023) discussed needed improvements in clinical documentation related specifically to the aged care sector.…”

Section: Virtual Special Issue On CDImentioning

confidence: 99%

“…The concept of specificity refers to the level of detail observable within data and is considered an “essential characteristic of high-quality data” (Roberts et al, 2023: 8). While specificity is recognised as important, it does not commonly feature in administrative data, often necessitating use of multiple data sources or data linkage for research and analytics (Duke et al, 2022; Kilkenny et al, 2022; Palamuthusingam and Pascoe, 2023; Roberts et al, 2023).…”

Section: Virtual Special Issue On CDImentioning

confidence: 99%

“…They found agreement between the Registry and hospital datasets was variable, with prevalence of comorbidities being higher in the Registry. A study by Duke et al (2022) also found the most frequently used coding method underpinning administrative data used for epidemiologic surveillance underestimated its prevalence. Hay et al (2020) reported that only 55% of laboratory-confirmed episodes of Staphylococcus aureus bacteraemia were reflected in the coded data, suggesting that inaccuracies were most likely due to documentation issues.…”

Section: Virtual Special Issue On CDImentioning

confidence: 99%

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Clinical documentation integrity: Its role in health data integrity, patient safety and quality outcomes and its impact on clinical coding and health information management

Davis,

Shepheard

2023

HIM J

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Clinical documentation has been defined as "information that is recorded about a person's care. The primary purpose of clinical documentation is to facilitate, safe, high quality and continuous care. . .and is stored within a health record" (Australian Commission on Safety and Quality in Healthcare, 2023). It needs to accurately reflect clinical events and decision-making for purposes of care continuity and communication. However, the quality and utility of clinical documentation has influence well beyond its primary purpose of supporting patient care. The World Health Organization has defined data integrity as:The degree to which data are complete, consistent, accurate, trustworthy, and reliable and that these characteristics of the data are maintained throughout the data life cycle. The data should be collected and maintained in a secure manner, such that they are attributable, legible, contemporaneously recorded, original or a true copy and accurate. Assuring data integrity requires appropriate quality and risk management systems, including adherence to sound scientific principles and good documentation practices (World Health Organization, 2016; cited in Victorian Agency for Health Information, 2018).

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Understanding the biases to sepsis surveillance and quality assurance caused by inaccurate coding in administrative health data

Schwarzkopf,

Rose,

Fleischmann-Struzek

et al. 2023

Infection

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Purpose Timely and accurate data on the epidemiology of sepsis are essential to inform policy decisions and research priorities. We aimed to investigate the validity of inpatient administrative health data (IAHD) for surveillance and quality assurance of sepsis care. Methods We conducted a retrospective validation study in a disproportional stratified random sample of 10,334 inpatient cases of age ≥ 15 years treated in 2015–2017 in ten German hospitals. The accuracy of coding of sepsis and risk factors for mortality in IAHD was assessed compared to reference standard diagnoses obtained by a chart review. Hospital-level risk-adjusted mortality of sepsis as calculated from IAHD information was compared to mortality calculated from chart review information. Results ICD-coding of sepsis in IAHD showed high positive predictive value (76.9–85.7% depending on sepsis definition), but low sensitivity (26.8–38%), which led to an underestimation of sepsis incidence (1.4% vs. 3.3% for severe sepsis-1). Not naming sepsis in the chart was strongly associated with under-coding of sepsis. The frequency of correctly naming sepsis and ICD-coding of sepsis varied strongly between hospitals (range of sensitivity of naming: 29–71.7%, of ICD-diagnosis: 10.7–58.5%). Risk-adjusted mortality of sepsis per hospital calculated from coding in IAHD showed no substantial correlation to reference standard risk-adjusted mortality (r = 0.09). Conclusion Due to the under-coding of sepsis in IAHD, previous epidemiological studies underestimated the burden of sepsis in Germany. There is a large variability between hospitals in accuracy of diagnosing and coding of sepsis. Therefore, IAHD alone is not suited to assess quality of sepsis care.

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Performance of hospital administrative data for detection of sepsis in Australia: The sepsis coding and documentation (SECOND) study

Abstract: This content has been temporarily removed for correction.

Cited by 3 publications

References 24 publications

Early sepsis in Australia and New Zealand: A point‐prevalence study of haemodynamic resuscitation practices

Early sepsis in Australia and New Zealand: A point‐prevalence study of haemodynamic resuscitation practices

Clinical documentation integrity: Its role in health data integrity, patient safety and quality outcomes and its impact on clinical coding and health information management

Understanding the biases to sepsis surveillance and quality assurance caused by inaccurate coding in administrative health data

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