Validity of the clinical and administrative databases in detecting post-operative adverse events.

Abstract

Patient safety has become a major public health concern and a priority for multiple institutions. Assessment of the adverse events is a key element for measuring the quality of healthcare organizations. The aim of this study was to measure the validity of the clinical and administrative database (CADB) as a source of information for the detection of post-operative adverse events. The study design was cross-sectional. The study was carried out at the Hospital de Navarra (north of Spain). The sample consisted of 1602 episodes of surgical hospitalization from nine surgical departments. Two sources of information were used: data extracted from the complete clinical record (CR), the gold standard, vs. the CADB. Rate of adverse events, sensitivity, positive predictive value and κ index were analysed for 28 types of post-operative adverse event. Each index was considered acceptable if it had a value >0.6. The rate of adverse events using the CADB was 12.5 vs. 24% using CR within 30 days of surgery (P = 0.0001) and 13.9% using CR during a hospital stay (P > 0.05). The overall sensitivity of the CADB in the detection of adverse events was 0.18, and the positive predictive value was 0.34. Two adverse events (accounted for 6% of the total events detected) had moderate validity and the rest poor validity. Forty-two per cent of the adverse events took place after patient discharge. Although the use of CADB is appealing, the present study suggests that it is of very limited value in the detection of adverse events post-operatively.