Journal
AMERICAN JOURNAL OF MEDICAL QUALITY
Volume 28, Issue 3, Pages 206-213Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1062860612459070
Keywords
AHRQ Patient Safety Indicators; processes of care; postoperative wound dehiscence; accidental puncture or laceration
Categories
Funding
- Department of Veterans Affairs Health Services Research and Development Service [SDR 07-002]
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This study examines whether Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) Postoperative Wound Dehiscence (PWD) and Accidental Puncture or Laceration (APL) events reflect problems with hospital processes of care (POC).The authors randomly selected 112 PSI-flagged PWD/APL discharges from 2002-2007 VA administrative data, identified true cases using chart review, and matched cases with controls.This yielded a total of 95 case-control pairs per PSI. Patient information and clinical processes on each case-control pair were abstracted from the electronic medical record (EMR).Although PWD cases and controls differed on incision and closure types,APL cases and controls were comparable in examined processes. Further exploration of the process differences between PWD cases and controls indicated that they were primarily caused by patients' underlying surgical problems rather than quality of care shortfalls. Documentation of POC was frequently missing in EMRs. Future studies should combine EMR review with alternative approaches, such as direct observation, to better assess POC.
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