Postadmission sepsis as a screen for quality problems: a case-control study.
The present on admission (POA) indicator used with diagnosis codes listed in hospital discharge abstracts makes it possible to screen for possible in-hospital complications, which may in turn point to quality of care problems. A case-control study was performed among 382 patients from 30 New York State hospitals to see if lapses in quality were associated with the development of postadmission sepsis. Cases with hospital-acquired sepsis (labeled not POA) were compared with matched controls without sepsis. The authors found that central venous catheters and emergently inserted peripheral intravenous catheters were associated with subsequent development of sepsis. Urethral catheters were associated with sepsis for medical patients but not for surgical patients. Adherence to several process of care guidelines was incomplete but none occurred statistically significantly more frequently among sepsis cases than controls. Using discharge abstract diagnosis codes to determine the presence of postadmission complications shows promise for identifying areas for quality improvement.
Yale University School of Medicine, New Haven, CT hughes.john@yale.edu.
John S
JS
Hughes
3M Health Information Systems, Wallingford, CT.
Jon
J
Eisenhandler
3M Health Information Systems, Wallingford, CT.
Norbert
N
Goldfield
Island Peer Review Organization, Lake Success, NY.
Patti G
PG
Weinberg
3M Health Information Systems, Wallingford, CT.
Richard
R
Averill
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*
present on admission; quality; screening; sepsis