title: Improving identification of postoperative respiratory failure missed by the patient safety indicator algorithm.
abstract: The Patient Safety Indicator postoperative respiratory failure (PRF) flags cases using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for acute respiratory failure or mechanical ventilation/intubation. The authors examined how frequently PRF missed events and ways to improve event identification. A total of 125 high-risk unflagged cases were selected based on predicted probability and presence of clinically relevant codes. False-negative (FN) proportion and associated reasons were determined through chart review, and likelihood ratios (LRs) of associated codes were calculated. In all, 27% of elective cases were FNs; 55% of FNs lacked ventilation/intubation codes. "Respiratory arrest," 799.1, had the highest LR (5.4) but occurred in only 8% of FNs. All other individual diagnostic or procedure codes had relatively low LRs (≤ 3.1), despite occurring in up to 36% of FNs. Among high-risk cases, the PRF algorithm often missed events. Improved ventilation/intubation coding will have more of an impact on case identification than adding ICD-9-CM codes to the algorithm.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, Bedford, MA 01730, USA. amb@bu.edu
authors.forename: Ann M
authors.initials: AM
authors.lastname: Borzecki
authors.forename: Marisa
authors.initials: M
authors.lastname: Cevasco
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.forename: Marlena
authors.initials: M
authors.lastname: Shin
authors.forename: Kamal M
authors.initials: KM
authors.lastname: Itani
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
mesh_terms: D000465:Algorithms; D001900:Boston / Q000453:epidemiology; D059019:Clinical Coding; D003430:Cross-Sectional Studies; D006787:Hospitals, Veterans; D006801:Humans; D016013:Likelihood Functions; D008485:Medical Audit; D061214:Patient Safety; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies