Detecting adverse events in surgery: comparing events detected by the Veterans Health Administration Surgical Quality Improvement Program and the Patient Safety Indicators.

Background: The Patient Safety Indicators (PSIs) use administrative data to screen for select adverse events (AEs). In this study, VA Surgical Quality Improvement Program (VASQIP) chart review data were used as the gold standard to measure the criterion validity of 5 surgical PSIs. Independent chart review was also used to determine reasons for PSI errors.

Development and testing of tools to detect ambulatory surgical adverse events.

Objectives: Numerous health-care systems in the United States, including the Veterans Health Administration (VA), use the National Surgical Quality Improvement Program (NSQIP) to detect surgical adverse events (AEs). VASQIP sampling methodology excludes many routine ambulatory surgeries from review. Triggers, algorithms derived from clinical logic to flag cases where AEs have most likely occurred, could complement VASQIP by detecting a higher yield of ambulatory surgeries with a true surgical AE.

How valid is the AHRQ Patient Safety Indicator "postoperative hemorrhage or hematoma"?

Background: Postoperative hemorrhage or hematoma (PHH), an Agency for Healthcare Research and Quality Patient Safety Indicator, uses administrative data to detect cases of potentially preventable postsurgical bleeding requiring a reparative procedure. How accurately it identifies true events is unknown. We therefore determined PHH's positive predictive value.

Validity of selected Patient Safety Indicators: opportunities and concerns.

Background: The Agency for Healthcare Research and Quality (AHRQ) recently designed the Patient Safety Indicators (PSIs) to detect potential safety-related adverse events. The National Quality Forum has endorsed several of these ICD-9-CM-based indicators as quality-of-care measures. We examined the positive predictive value (PPV) of 3 surgical PSIs: postoperative pulmonary embolus and deep vein thrombosis (pPE/DVT), iatrogenic pneumothorax (iPTX), and accidental puncture and laceration (APL).