Trigger tools have potential to detect adverse events following outpatient surgery
Applying clinical logic to patient electronic medical records (EMRs) as "triggers" can accurately identify outpatient (same-day) surgeries likely to produce adverse events following surgery, concludes a new study. It found that two triggers, pulmonary embolism or deep-vein thrombosis (PE/DVT) within 30 days of the operation, and an emergency department visit within 21 days, were highly predictive of adverse events following outpatient surgery. Three other triggers (hospital admission within 30 days of the surgery, hospital admission for longer than 24 hours, and certain intervention procedures or reoperation within 30 days) were much less precise in identifying a likely adverse event.
Amy Helwig, M.D., of the Agency for Healthcare Research and Quality, and fellow researchers ran all five triggers on EMR data from patients who underwent outpatient surgeries at participating institutions. As a result, 6,688 of 17,492 records were flagged that had at least 1 trigger. Nurses looked at each flagged record to identify adverse events occurring within 30 days of the outpatient surgery. The percent of cases flagged ranged from 1.1 percent to 22 percent, depending on the trigger. The PE/DVT trigger, though flagging the smallest number of cases (189, or 1.1 percent), had the highest positive predictive value (PPV), 62 percent for any adverse event. The other triggers' PPVs for any adverse event ranged from 6 percent (the procedure trigger, which flagged 1,135 cases) to 23 percent (the hospital admission trigger, which flagged 3,846 cases).
The researchers obtained de-identified patient data from three health care systems interested in the use of triggers. Eligible adults had surgery during 2007 and had at least one clinical note within 6 months of the surgery. The study was funded in part by the Agency for Healthcare Research and Quality (Contract No. 290-02-0600).
More details are in "Applying trigger tools to detect adverse events associated with outpatient surgery," by Amy K. Rosen, Ph.D., Hillary J. Mull, M.P.P., Haytham Kaafarani, M.D., M.P.H., and others in the March 2011 Journal of Patient Safety 7(1), pp. 45-59. Reprints (Publication No. 11-R042) are available from the AHRQ Publications Clearinghouse.
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