Cases of Iatrogenic Pneumothorax Can Be Identified From ICD-9-CM Coded Data

Abstract

Hospital administrative data are being used to identify hospitals with hospital-acquired complications such as iatrogenic pneumothorax. This was a retrospective cross-sectional study of hospitalization records to estimate the positive predictive value (PPV) of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for iatrogenic pneumothorax. A probability sample of inpatient medical records from 2006 to 2007 was reviewed in a national sample of 28 volunteer hospitals. Among the 200 flagged cases, the PPV was 78% (95% confidence interval = 73%-82%). False positive cases were mostly a result of exclusionary conditions (11%) and pneumothoraxes that were present on admission (7%). About 44% of events followed attempted central venous catheter (CVC) placement. Of the 69 CVCassociated events, only 5 occurred with ultrasound guidance. AHRQ’s iatrogenic pneumothorax indicator can serve in quality of care improvement. At least 1725 hospital-acquired pneumothoraxes could have been prevented in 2004 through universal use of ultrasound guidance during internal jugular cannulation.

Keywords

patient safety indicators ICD-9-CM data iatrogenic pneumothorax Agency for Healthcare Research and Quality

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References

Ayas NT , Norena M. , Wong H. , Chittock D. , Dodek PM Pneumothorax after insertion of central venous catheters in the intensive care unit: association with month of year and week of month. Qual Saf Health Care. 2007;16:252-255.

Marderstein EL , Simmons RL , Ochoa JB Patient safety: effect of institutional protocols on adverse events related to feeding tube placement in the critically ill . J Am Coll Surg. 2004;199:39-47, discussion 47-50.

Zhan C. , Miller MR Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290:1868-1874.

Zhan C. , Smith M. , Stryer D. Accidental iatrogenic pneumothorax in hospitalized patients. Med Care. 2006;44:182-186.

Hind D. , Calvert N. , McWilliams R. , et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ. 2003;327:361.

Karakitsos D. , Labropoulos N. , De Groot E. , et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care. 2006 ;10:R162.

Calvert N. , Hind D. , McWilliams RG , Thomas SM , Beverley C. , Davidson A. The effectiveness and cost-effectiveness of ultrasound locating devices for central venous access: a systematic review and economic evaluation. Health Technol Assess (Rocky). 2003 ;7:1-84.

Gualtieri E. , Deppe SA , Sipperly ME , Thompson DR Subclavian venous catheterization: greater success rate for less experienced operators using ultrasound guidance. Crit Care Med. 1995;23:692-697.

Agency for Healthcare Research and Quality. Patient safety indicators. http://qualityindicators.ahrq.gov/downloads/psi/2006-Feb-PatientSafetyIndicators.pdf. Accessed March 24, 2009.

10.

Scanlon MC , Harris JM II , Levy F. , Sedman A. Evaluation of the Agency for Healthcare Research and Quality pediatric quality indicators. Pediatrics. 2008;121:e1723-e1731.

11.

Centers for Medicare and Medicaid Services. 2008 IPPS rule: Medicare program; changes to the hospital inpatient prospective payment. http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1390-F.pdf. Accessed March 24, 2009.

12.

Hospital Quality Alliance. Web site. http://www.hospitalqualityalliance.org/. Accessed March 24, 2009.

13.

Romano PS , Zrelak P. , Utter G. , et al. Positive predictive value of AHRQ patient safety indicators in a national sample of hospitals. http://www.academyhealth.org/files/2008/monday/virginiac/6_9_2008_11_30/zrelak.ppt. Accessed December 23, 2009.

14.

Brandstetter RD , Karetzky M. , Rastogi R. , Lolis JD Pneumothorax after thoracentesis in chronic obstructive pulmonary disease. Heart Lung. 1994;23:67-70.

15.

Bahl V. , Thompson MA , Kau TY , Hu HM , Campbell DA Jr. Do the AHRQ patient safety indicators flag conditions that are present at the time of hospital admission? Med Care. 2008;46:516-522.

16.

Houchens RL , Elixhauser A. , Romano PS How often are potential patient safety events present on admission? Jt Comm J Qual Patient Saf. 2008;34:154-163.

17.

Naessens JM , Campbell CR , Berg B. , Williams AR , Culbertson R. Impact of diagnosis-timing indicators on measures of safety, comorbidity, and case mix groupings from administrative data sources . Med Care. 2007;45:781-788.

18.

Quan H. , Parsons GA , Ghali WA Assessing accuracy of diagnosis-type indicators for flagging complicationsin administrative data. J Clin Epidemiol. 2004 ;51:366-372.

19.

Agency for Healthcare Research and Quality. 2007 Patient safety indicators (provider level). http://qualityindicators.ahrq.gov/downloads/psi/psi_provider_comparative_v31.pdf. Accessed March 24, 2009.

20.

AHRQ quality indicators. 2007 Patient safety indicators (area level). Available at: http://qualityindicators.ahrq.gov/downloads/psi/psi_area_comparative_v31.pdf . Accessed March 25, 2009.

21.

Agency for Healthcare Research and Quality. 2007 Pediatric quality indicators. http://qualityindicators.ahrq.gov/downloads/pdi/pdi_provider_comparative_v31.pdf .Accessed March 25, 2009.

22.

Rosen AK , Zhao S. , Rivard P. , et al. Tracking rates of patient safety indicators over time: lessons from the Veterans Administration. Med Care. 2006;44:850-861.

23.

Calvert N. , Hind D. , McWilliams R. , Davidson A. , Beverley CA , Thomas SM Ultrasound for central venous cannulation: economic evaluation of cost-effectiveness . Anaesthesia. 2004;59:1116-1120.

24.

Agency for Healthcare Research and Quality. Welcome to HCUPnet. http://hcupnet.ahrq.gov . Accessed September 23, 2008.