title: Triangulating case-finding tools for patient safety surveillance: a cross-sectional case study of puncture/laceration.
abstract: OBJECTIVE
  To evaluate the need for triangulating case-finding tools in patient safety surveillance. This study applied four case-finding tools to error-associated patient safety events to identify and characterise the spectrum of events captured by these tools, using puncture or laceration as an example for in-depth analysis.
  
  
  METHODS
  Retrospective hospital discharge data were collected for calendar year 2005 (n=48,418) from a large, urban medical centre in the USA.
  
  
  METHODS
  The study design was cross-sectional and used data linkage to identify the cases captured by each of four case-finding tools.
  
  
  METHODS
  Three case-finding tools (International Classification of Diseases external (E) and nature (N) of injury codes, Patient Safety Indicators (PSI)) were applied to the administrative discharge data to identify potential patient safety events. The fourth tool was Patient Safety Net, a web-based voluntary patient safety event reporting system.
  
  
  RESULTS
  The degree of mutual exclusion among detection methods was substantial. For example, when linking puncture or laceration on unique identifiers, out of 447 potential events, 118 were identical between PSI and E-codes, 152 were identical between N-codes and E-codes and 188 were identical between PSI and N-codes. Only 100 events that were identified by PSI, E-codes and N-codes were identical. Triangulation of multiple tools through data linkage captures potential patient safety events most comprehensively.
  
  
  CONCLUSIONS
  Existing detection tools target patient safety domains differently, and consequently capture different occurrences, necessitating the integration of data from a combination of tools to fully estimate the total burden.
authors.affiliation: Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania 19102, USA. Jat65@drexel.edu
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Taylor
authors.forename: Daniel
authors.initials: D
authors.lastname: Gerwin
authors.forename: Laura
authors.initials: L
authors.lastname: Morlock
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D000328:Adult; D059019:Clinical Coding / Q000379:methods* / Q000592:standards; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods* / Q000592:standards; D005260:Female; D006761:Hospitals; D006801:Humans; D022125:Lacerations / Q000453:epidemiology*; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D061214:Patient Safety; D011159:Population Surveillance / Q000379:methods*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D017751:Safety Management / Q000379:methods; D014950:Wounds, Penetrating / Q000453:epidemiology*