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Patient Safety: Achieving a New Standard for Care
In addition to ADEs, automated surveillance approaches have proven to be effective in identifying nosocomial infections and falls (Bates et al., 2003), although these approaches are not used routinely. Evans et al. (1986) demonstrated that computerized surveillance is at least as effective as traditional surveillance methods used by infection control practitioners for identifying hospital-acquired infections. Natural language processing was used to search radiology reports for indications that a patient fall after the second day of hospitalization was a reason for the radiological examination (Bates et al., 2003).
Although there has been considerable success in using automated surveillance techniques for detecting certain types of adverse events, there will continue to be many problems that will make automated detection without manual over-read challenging. For example, in searching anesthesia records for problems arising from the management of diabetes in the peri-operative period, large amounts of redundant information might be picked up as a result of patients having iatrogenic diabetes in the peri-operative period.
In conclusion, for ADEs, and probably for other types of adverse events as well, the three approaches to event detection reviewed—automated surveillance, chart review, and voluntary reporting—complement each other, with voluntary reporting being most effective at identifying potential adverse events or near misses (see Chapter 7). It is also likely that these three methods complement patient monitoring systems. Any patient safety data standards developed must be supportive of all the above detection methods.
Data Requirements for Adverse Event Detection
Voluntary and Mandatory Reporting
To encourage people to report, voluntary reporting tends not to be prescriptive about what types of events are to be reported or what information should be supplied. Generally, just a short description of what happened is required. The recipient of the report is then tasked with creating a report for analysis purposes.
Mandatory reporting systems usually specify in some detail the types of adverse events that must be reported and analyzed. For example, in New York State all hospitals (inpatient and outpatient) and freestanding clinics must report a wide range of adverse events to the New York Patient Occurrence Reporting and Tracking System (see Appendix C).