title: An adverse event screening tool based on routinely collected hospital-acquired diagnoses.
abstract: OBJECTIVE
  The aim was to develop an electronic adverse event (AE) screening tool applicable to acute care hospital episodes for patients admitted with chronic heart failure (CHF) and pneumonia.
  
  
  METHODS
  Consensus building using a modified Delphi method and descriptive analysis of hospital discharge data.
  
  
  METHODS
  Consultant physicians in general medicine (n = 38).
  
  
  METHODS
  In-hospital acquired (C-prefix) diagnoses associated with CHF and pneumonia admissions to 230 hospitals in Victoria, Australia, were extracted from the Victorian Admitted Episodes Data Set between July 2004 and June 2007. A 9-point rating scale was used to prioritize diagnoses acquired during hospitalization (routinely coded as a 'C-prefix' diagnosis to distinguish from diagnoses present on admission) for inclusion within an AE screening tool. Diagnoses rated a group median score between 7 and 9 by the physician panel were included.
  
  
  METHODS
  Selection of C-prefix diagnoses with a group median rating of 7-9 in a screening tool, and the level of physician agreement, as assessed using the Interpercentile Range Adjusted for Symmetry.
  
  
  RESULTS
  Of 697 initial C-prefix diagnoses, there were high levels of agreement to include 113 (16.2%) in the AE screening tool. Using these selected diagnoses, a potential AE was flagged in 14% of all admissions for the two index conditions. Intra-rater reliability for each clinician ranged from kappa 0.482 to 1.0.
  
  
  CONCLUSIONS
  A high level of physician agreement was obtained in selecting in-hospital diagnoses for inclusion in an AE screening tool based on routinely collected data. These results support further tool validation.
authors.affiliation: Centre for Research Excellence in Patient Safety, Monash University, Melbourne, Victoria, Australia. caroline.brand@mh.org.au
authors.forename: Caroline
authors.initials: C
authors.lastname: Brand
authors.forename: Joanne
authors.initials: J
authors.lastname: Tropea
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gorelik
authors.forename: Damien
authors.initials: D
authors.lastname: Jolley
authors.forename: Ian
authors.initials: I
authors.lastname: Scott
authors.forename: Vijaya
authors.initials: V
authors.lastname: Sundararajan
mesh_terms: D002908:Chronic Disease; D003697:Delphi Technique; D057286:Electronic Health Records; D017050:Episode of Care; D006333:Heart Failure / Q000175:diagnosis*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D010343:Patient Admission; D011014:Pneumonia / Q000175:diagnosis*; D019984:Quality Indicators, Health Care; D012308:Risk Management