IDENTIFICATION OF UNDESIRABLE POST-OPERATIVE EVENTS USING ROUTINELY ACQUIRED HOSPITAL DATA: DEVELOPMENT OF AN AUDIT TOOL USING KNEE ARTHROSCOPY AS A MODEL

A E Fox; D S Johnson; D Havely; G E Cook

doi:10.1302/0301-620X.91BSUPP_III.0910422

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IDENTIFICATION OF UNDESIRABLE POST-OPERATIVE EVENTS USING ROUTINELY ACQUIRED HOSPITAL DATA: DEVELOPMENT OF AN AUDIT TOOL USING KNEE ARTHROSCOPY AS A MODEL

A E Fox
D S Johnson
D Havely
G E Cook

IDENTIFICATION OF UNDESIRABLE POST-OPERATIVE EVENTS USING ROUTINELY ACQUIRED HOSPITAL DATA: DEVELOPMENT OF AN AUDIT TOOL USING KNEE ARTHROSCOPY AS A MODEL

Fox AE, Johnson DS, Havely D, Cook GE. IDENTIFICATION OF UNDESIRABLE POST-OPERATIVE EVENTS USING ROUTINELY ACQUIRED HOSPITAL DATA: DEVELOPMENT OF AN AUDIT TOOL USING KNEE ARTHROSCOPY AS A MODEL. Orthop Procs. 2009;91-B(SUPP_III):422-422. doi:10.1302/0301-620X.91BSUPP_III.0910422

Fox, A E, et al. “IDENTIFICATION OF UNDESIRABLE POST-OPERATIVE EVENTS USING ROUTINELY ACQUIRED HOSPITAL DATA: DEVELOPMENT OF AN AUDIT TOOL USING KNEE ARTHROSCOPY AS A MODEL.” Orthopaedic Proceedings, vol. 91-B, no. SUPP_III, 2009, pp. 422-422., https://doi.org/10.1302/0301-620X.91BSUPP_III.0910422

Fox, A. E., Johnson, D. S., Havely, D., & Cook, G. E. (2009). IDENTIFICATION OF UNDESIRABLE POST-OPERATIVE EVENTS USING ROUTINELY ACQUIRED HOSPITAL DATA: DEVELOPMENT OF AN AUDIT TOOL USING KNEE ARTHROSCOPY AS A MODEL. Orthopaedic Proceedings, 91-B(SUPP_III), 422-422. https://doi.org/10.1302/0301-620X.91BSUPP_III.0910422

Fox, A. E., Johnson, D. S., Havely, D. and Cook, G. E. (2009) “IDENTIFICATION OF UNDESIRABLE POST-OPERATIVE EVENTS USING ROUTINELY ACQUIRED HOSPITAL DATA: DEVELOPMENT OF AN AUDIT TOOL USING KNEE ARTHROSCOPY AS A MODEL.” Orthopaedic Proceedings, 91-B(SUPP_III), pp. 422-422. Available at: https://doi.org/10.1302/0301-620X.91BSUPP_III.0910422

Fox, A E, D S Johnson, D Havely, and G E Cook. “IDENTIFICATION OF UNDESIRABLE POST-OPERATIVE EVENTS USING ROUTINELY ACQUIRED HOSPITAL DATA: DEVELOPMENT OF AN AUDIT TOOL USING KNEE ARTHROSCOPY AS A MODEL.” Orthopaedic Proceedings 91-B, no. SUPP_III (2009): 422-422. https://doi.org/10.1302/0301-620X.91BSUPP_III.0910422

Fox AE, Johnson DS, Havely D, Cook GE. IDENTIFICATION OF UNDESIRABLE POST-OPERATIVE EVENTS USING ROUTINELY ACQUIRED HOSPITAL DATA: DEVELOPMENT OF AN AUDIT TOOL USING KNEE ARTHROSCOPY AS A MODEL. Orthop Procs. 2009 Sep 1;91-B(SUPP_III):422-422. https://doi.org/10.1302/0301-620X.91BSUPP_III.0910422

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Abstract

Purpose of Study: We aimed to reduce the work intensity involved in auditing high volume procedures (eg knee arthroscopy) by developing and validating a tool which uses routinely acquired hospital data, to target those patients most likely to have developed an undesirable post-operative outcome.

Methodology: The work was a collaboration effort between the Orthopaedic and Clinical Effectiveness departments. During the period 1997–2003, 2926 elective knee arthroscopies were identified as having been performed in our unit. Linkage of routinely collected data held on the hospital’s computerized Patient Administrative System (PAS), hospital theatre system and A& E system, with data from the Office of National Statistics concerning death, high-lighted 183 cases (Core group) meeting one or more of four indicators: readmission < 28 days, return to theatre < 28 days, return to A& E < 28 days, and length of stay 4+ days (Graph 1). The accuracy of the tool to identify undesirable post-operative outcomes was made comparing the Core group and a Random sample (N=240).

Results: Accuracy of OPCS-4 coding for arthroscopic procedure performed was 77.1% in the core group and 96.4% in the random sample. The new tool yielded a sensitivity of 38% and specificity of 95%. Where major complications were concerned the sensitivity rose to 100%. For major complications the proposed model indicated a 0.6% complication rate vs 0.5% actual rate. For minor complications the proposed model indicated a 1.4% rate vs 3.8% actual rate. Overall complication rate within our unit was comparable to the published literature.

Conclusion: The tool has achieved its aim of identifying all major complications and undesirable events, along with many minor complications. As the tool identifies additional information it must be used as an aid to identifying patients for case note review. However, in our study it reduced the number needed to less than 7% of the total.

Correspondence should be addressed to Mr T Wilton, c/o BOA, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.