2.50
Hdl Handle:
http://hdl.handle.net/10755/157432
Type:
Presentation
Title:
AHRQ Patient Safety Indicator Validation Pilot and its Relevance to Nursing
Abstract:
AHRQ Patient Safety Indicator Validation Pilot and its Relevance to Nursing
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Zrelak, Patricia, PhD
P.I. Institution Name:UC Davis Medical Center, Center for Healthcare Policy and Research
Title:Nurse Researcher
Contact Address:2103 Stockton Blvd., Suite 2224, Sacramento, CA, 95817, USA
Contact Telephone:916 734-8931
Co-Authors:Ruth Baron, BSN, RN, Nurse Researcher; Cheryl Davies, MS, Project Manager; Jeff Geppert, JD, Research Leader; Patrick Romano, MD, MPH, Professor of Medicine; Banafsheh Sadeghi, PhD, Post-doc; Garth Utter, MD, MS, Trauma Surgeon
Purpose: The Patient Safety Indicator (PSI) Validation Pilot Project was designed to: develop medical record abstraction tools, gather evidence on criterion validity through medical record review, improve guidance about how to interpret PSI rates, evaluate potential specification changes, and pilot a system for ongoing validation studies.  Rationale:  Hospitalized patients are at high risk for iatrogenic complications and safety-related events.  The AHRQ PSIs, based on ICD-9-CM discharge data in the US, has become a widely used tool for identifying these potentially preventable and often serious events. Methods:  The study was divided into three temporal phases.  In Phase I, the focus of this presentation, we set out to determine the positive predictive value (PPV) (the proportion of all positive cases that were true positives) of five PSIs (Accidental Puncture or Laceration, Iatrogenic Pneumothorax, Postoperative DVT/PE, Postoperative Sepsis, and Selected Infections Due to Medical Care).  Phase II is addressing the PPV of five additional PSIs (Foreign Body, Postoperative Hemorrhage or Hematoma, Postoperative Metabolic Derangement, Postoperative Wound Dehiscence, and Postoperative Respiratory Failure).  Phase III is addressing missed cases (sensitivity or false negatives).  For Phase I, volunteer hospitals across the US were recruited to abstract up to 30 records flagged as positive per PSI per hospital using standard medical record abstraction tools.  Besides case ascertainment, abstraction tools targeted processes of care, diagnosis, treatment and associated outcomes.  Support to volunteers was provided through training webinars, written documents, electronic discussions, and central feedback. Results:  For "postoperative DVT/PE" (N=155; 25 hospitals), the PPV was 83%, although it dropped to 48% if pre-operative thromboses and thromboses involving superficial, upper extremity, and thoracic veins were classified as incorrect or false positive cases.  The PPV for "postoperative sepsis" (N=164; 21 hospitals) was 68%.  For "selected infections due to medical care" (N=189; 27 hospitals), PPV was 61% with 54% of confirmed events being central-catheter-related.  For "accidental puncture and laceration" (N=250; 22 hospitals), the PPV was 91% with 69% of events requiring a reparative procedure.  PPV for "iatrogenic pneumothorax" (N=200; 28 hospitals) was 78% with 42% of events due to Central-Venous-Catheter placement.  Abstracted data on nursing interventions that may affect these PSI rates include postoperative ambulation, DVT prophylaxis, management of indwelling catheters, PICC insertion, central catheter management, surgical site prep, and antibiotic management in the surgical patient. Implications:  The PPVs of the phase I AHRQ PSIs in a sample of US hospitals varied from 61 to 91%.  Proposed coding changes and use of "present on admission" data is expected to improve most of these PPVs.  Additional work is needed before using the PSIs for national reporting or pay-for-performance.  The PSIs can be used internally to evaluate patient safety through the review of rates and flagged cases. Abstraction tools may be used to further assess processes of care and related-outcomes, such as those associated with nursing care.  Phase I indicators most relevant to nursing include: postoperative DVT/PE, selected infections due to medical care, and postoperative sepsis.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleAHRQ Patient Safety Indicator Validation Pilot and its Relevance to Nursingen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157432-
dc.description.abstract<table><tr><td colspan="2" class="item-title">AHRQ Patient Safety Indicator Validation Pilot and its Relevance to Nursing</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Zrelak, Patricia, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">UC Davis Medical Center, Center for Healthcare Policy and Research</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Researcher</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2103 Stockton Blvd., Suite 2224, Sacramento, CA, 95817, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">916 734-8931</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">pazrelak@ucdavis.edu, pzrelak@aol.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Ruth Baron, BSN, RN, Nurse Researcher; Cheryl Davies, MS, Project Manager; Jeff Geppert, JD, Research Leader; Patrick Romano, MD, MPH, Professor of Medicine; Banafsheh Sadeghi, PhD, Post-doc; Garth Utter, MD, MS, Trauma Surgeon</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The Patient Safety Indicator (PSI) Validation Pilot Project was designed to: develop medical record abstraction tools, gather evidence on criterion validity through medical record review, improve guidance about how to interpret PSI rates, evaluate potential specification changes, and pilot a system for ongoing validation studies.&nbsp; Rationale:&nbsp; Hospitalized patients are at high risk for iatrogenic complications and safety-related events.&nbsp; The AHRQ&nbsp;PSIs, based on ICD-9-CM discharge data in the US, has become a widely used tool for identifying these potentially preventable and often serious events. Methods:&nbsp; The study was divided into three temporal phases.&nbsp; In Phase I, the focus of this presentation, we set out to determine the positive predictive value (PPV) (the proportion of all positive cases that were true positives) of five PSIs (Accidental Puncture or Laceration, Iatrogenic Pneumothorax, Postoperative DVT/PE, Postoperative Sepsis, and Selected Infections Due to Medical Care).&nbsp; Phase II is addressing the PPV of five additional PSIs (Foreign Body, Postoperative Hemorrhage or Hematoma, Postoperative Metabolic Derangement, Postoperative Wound Dehiscence, and Postoperative Respiratory Failure).&nbsp; Phase III is addressing missed cases (sensitivity or false negatives).&nbsp; For Phase I, volunteer hospitals across the US were recruited to abstract up to 30 records flagged as positive per PSI per hospital using standard medical record abstraction tools.&nbsp; Besides case ascertainment, abstraction tools targeted processes of care, diagnosis, treatment and associated outcomes.&nbsp; Support to volunteers was provided through training webinars, written documents, electronic discussions, and central feedback. Results:&nbsp; For &quot;postoperative DVT/PE&quot; (N=155; 25 hospitals), the PPV was 83%, although it dropped to 48% if pre-operative thromboses and thromboses involving superficial, upper extremity, and thoracic veins were classified as incorrect or false positive cases.&nbsp; The PPV for &quot;postoperative sepsis&quot; (N=164; 21 hospitals) was 68%.&nbsp; For &quot;selected infections due to medical care&quot; (N=189; 27 hospitals), PPV was 61% with 54% of confirmed events being central-catheter-related.&nbsp; For &quot;accidental puncture and laceration&quot; (N=250; 22 hospitals), the PPV was 91% with 69% of events requiring a reparative procedure.&nbsp; PPV for &quot;iatrogenic pneumothorax&quot; (N=200; 28 hospitals) was 78% with 42% of events due to Central-Venous-Catheter placement.&nbsp; Abstracted data on nursing interventions that may affect these PSI rates include postoperative ambulation, DVT prophylaxis, management of indwelling catheters, PICC insertion, central catheter management, surgical site prep, and antibiotic management in the surgical patient. Implications: &nbsp;The PPVs of the phase I AHRQ PSIs in a sample of US hospitals varied from 61 to 91%. &nbsp;Proposed coding changes and use of &quot;present on admission&quot; data is expected to improve most of these PPVs.&nbsp; Additional work is needed before using the PSIs for national reporting or pay-for-performance.&nbsp; The PSIs can be used internally to evaluate patient safety through the review of rates and flagged cases. Abstraction tools may be used to further assess processes of care and related-outcomes, such as those associated with nursing care. &nbsp;Phase I indicators most relevant to nursing include: postoperative DVT/PE, selected infections due to medical care, and postoperative sepsis.</td></tr></table>en_GB
dc.date.available2011-10-26T19:52:04Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:52:04Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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