title: Examining the relationship between processes of care and selected AHRQ patient safety indicators postoperative wound dehiscence and accidental puncture or laceration using the VA electronic medical record.
abstract: This study examines whether Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) Postoperative Wound Dehiscence (PWD) and Accidental Puncture or Laceration (APL) events reflect problems with hospital processes of care (POC). The authors randomly selected 112 PSI-flagged PWD/APL discharges from 2002-2007 VA administrative data, identified true cases using chart review, and matched cases with controls. This yielded a total of 95 case-control pairs per PSI. Patient information and clinical processes on each case-control pair were abstracted from the electronic medical record (EMR). Although PWD cases and controls differed on incision and closure types, APL cases and controls were comparable in examined processes. Further exploration of the process differences between PWD cases and controls indicated that they were primarily caused by patients' underlying surgical problems rather than quality of care shortfalls. Documentation of POC was frequently missing in EMRs. Future studies should combine EMR review with alternative approaches, such as direct observation, to better assess POC.
authors.affiliation: VA Boston Healthcare System, Boston, MA 02130, USA. qc2112@bu.edu
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.forename: Ann M
authors.initials: AM
authors.lastname: Borzecki
authors.forename: Marisa
authors.initials: M
authors.lastname: Cevasco
authors.forename: Marlena H
authors.initials: MH
authors.lastname: Shin
authors.forename: Michael
authors.initials: M
authors.lastname: Shwartz
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000368:Aged; D016022:Case-Control Studies; D057286:Electronic Health Records; D005260:Female; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D022125:Lacerations / Q000453:epidemiology / Q000209:etiology; D008297:Male; D061214:Patient Safety / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D013529:Surgical Wound Dehiscence / Q000453:epidemiology*; D014481:United States; D016270:United States Agency for Healthcare Research and Quality / Q000592:standards*; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000209:etiology