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

Abstract

Objective: 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. Design: The study design was cross-sectional. Setting: The study was carried out at the Hospital de Navarra (north of Spain). Participants: 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. Main outcomes: 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. Results: 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. Conclusions: 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.