Term definitions should also include a precise description of the groups of patients who are included and excluded. As noted above, for example, DQIP excludes patients with diagnoses such as gestational diabetes, a condition that generally resolves once the pregnancy is over.
Precise definitions facilitate the prospective collection of data on similar events and an understanding of how the rate of these events is altered by interventions. They also allow large numbers of near misses and minor incidents to be analyzed (see Chapter 7). From a practical standpoint, health care workers need assistance when collecting data using such detailed definitions. For example, the appropriate definitions might appear on a computer screen when the data are being collected.
To specify definitions and potential uses of terms to be included in an adverse event system, it is necessary to have minimum data requirements for the system. These minimum requirements should be stated and defined explicitly.
Regardless of how an adverse event is detected, the process for reporting and analyzing is essentially the same. Data are collected on each adverse event. Using these data, a subset of adverse events (as well as near misses; see Chapter 7) is analyzed to determine their root causes and recovery procedures. Improvements in the delivery of care are then devised and implemented. Aggregate analyses of adverse events for which the more detailed analyses were not carried out may also lead to improvements in the delivery of care.
Once an adverse event has been validated, the committee believes a report of the event should be a combination of narrative and coded elements. Coding is essential if large numbers of events are to be analyzed efficiently. However, any given coding system reflects a particular understanding of the key features of adverse events. Additional research can lead to new perspectives on what constitutes such features, and the availability of a narrative enables the adverse event to be recoded based on this new understanding.
At a minimum, the narrative text should give a brief description of what happened and the reporter’s view of why it happened. Using the narrative and further information from the medical record, and possibly from the reporter, an adverse event record should be coded along the following dimensions (at a minimum):