Evaluation of a pilot surgical adverse event detection system for italian hospitals

Objective: To devise an adverse event (AE) detection system and assess its validity and utility. Design: Observational, retrospective study. Setting: Six public hospitals in Northern Italy including a Teaching Hospital. Participants: Eligible cases were all patients with at least one admission to a surgical ward, over a 3-month period. Interventions: Computerized screening of administrative data and review of flagged charts by an independent panel. Main Outcome Measures: Number of records needed to identify an AE using this detection system. Results: Out of the 3310 eligible cases, 436 (13%) were extracted by computerized screening. In addition, out of the 2874 unflagged cases, 77 randomly extracted records (3%) were added to the sample, to measure unidentified cases. Nursing staff judged 108 of 504 (21%) charts positive for one or more criteria; surgeons confirmed the occurrence of AEs in 80 of 108 (74%) of these. Compared with random chart review, the number of cases needed to detect an AE, with the computerized screening suggested by this study, was reduced by two-thirds, although sensitivity was low (41%). Conclusions: This approach has the potential to allow the timely identification of AEs, enabling to quickly devise interventions. This detection system could be of true benefit for hospitals that intend assessing their AEs.