A comparison of hospital adverse events identified by three widely used detection methods.
OBJECTIVE
Determine the degree of congruence between several measures of adverse events.


METHODS
Cross-sectional study to assess frequency and type of adverse events identified using a variety of methods.


METHODS
Mayo Clinic Rochester hospitals.


METHODS
All inpatients discharged in 2005 (n = 60 599).


METHODS
Adverse events were identified through multiple methods: (i) Agency for Healthcare Research and Quality-defined patient safety indicators (PSIs) using ICD-9 diagnosis codes from administrative discharge abstracts, (ii) provider-reported events, and (iii) Institute for Healthcare Improvement Global Trigger Tool with physician confirmation. PSIs were adjusted to exclude patient conditions present at admission.


METHODS
Agreement of identification between methods.


RESULTS
About 4% (2401) of hospital discharges had an adverse event identified by at least one method. Around 38% (922) of identified events were provider-reported events. Nearly 43% of provider-reported adverse events were skin integrity events, 23% medication events, 21% falls, 1.8% equipment events and 37% miscellaneous events. Patients with adverse events identified by one method were not usually identified using another method. Only 97 (6.2%) of hospitalizations with a PSI also had a provider-reported event and only 10.5% of provider-reported events had a PSI.


CONCLUSIONS
Different detection methods identified different adverse events. Findings are consistent with studies that recommend combining approaches to measure patient safety for internal quality improvement. Potential reported adverse event inconsistencies, low association with documented harm and reporting differences across organizations, however, raise concerns about using these patient safety measures for public reporting and organizational performance comparison.
Naessens
James M
JM
Health Care Policy and Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA. naessens@mayo.edu
Campbell
Claudia R
CR
Huddleston
Jeanne M
JM
Berg
Bjorn P
BP
Lefante
John J
JJ
Williams
Arthur R
AR
Culbertson
Richard A
RA
D003430:Cross-Sectional Studies; D004282:Documentation; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D019300:Medical Errors / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D017751:Safety Management / Q000706:statistics & numerical data*; D014481:United States; D016270:United States Agency for Healthcare Research and Quality / Q000706:statistics & numerical data