Electronically Screening Discharge Electronically Screening Discharge Summaries for Adverse Medical EventsSummaries for Adverse Medical Events

Harvey J. Murff, MD, MPH, Alan J. Forster, MD, MSc, Josh F. Harvey J. Murff, MD, MPH, Alan J. Forster, MD, MSc, Josh F. Peterson, MD, MPH, Julie M. Fiskio, BA, Heather L. Heiman, Peterson, MD, MPH, Julie M. Fiskio, BA, Heather L. Heiman,

MD, David W. Bates, MD, MScMD, David W. Bates, MD, MScJournal of the American Medical Informatics Association 2003

S.Y. Song 2006/10/23

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IntroductionIntroduction MethodsMethods ResultsResults DiscussionDiscussion ConclusionsConclusions My observation My observation

IntroductionIntroduction

Adverse events (AEs) defined :Adverse events (AEs) defined :an injury caused by medical management an injury caused by medical management rather than patient’s underlying condition.rather than patient’s underlying condition.

In the United States some study show the In the United States some study show the rate of AEs ranging from 2.9% to 16.6%.rate of AEs ranging from 2.9% to 16.6%.

Estimates the Taiwan area, the death Estimates the Taiwan area, the death population cause by AEs approximately is population cause by AEs approximately is 6,000 to 20,000 every year. (2003 6,000 to 20,000 every year. (2003 醫策會醫策會))

IntroductionIntroduction

The key goal in The key goal in health care quality health care quality improvement.improvement.

How to measure it?How to measure it?

Manual review or Manual review or computerized computerized screening?screening?

MethodsMethods Sample selectionSample selection

this hospital policy requests physicians this hospital policy requests physicians complete discharge summaries within 30 complete discharge summaries within 30 days, that patients hospitalized more than days, that patients hospitalized more than 72 hours. 72 hours.

Some medical records “lack” some Some medical records “lack” some information will banish.information will banish.

2 cohort.2 cohort.

MethodsMethods

Harvard Medical Practice Study (MPS) Harvard Medical Practice Study (MPS) a two-step review process with nurse and a two-step review process with nurse and physician.physician.

Adverse events categories select.Adverse events categories select.18 categories reduce to 11 categories.18 categories reduce to 11 categories.

Search only section “ hospital course ” of Search only section “ hospital course ” of discharge summaries.discharge summaries.

MethodsMethods

Trigger words: the words related to AEs.Trigger words: the words related to AEs.

Trigger word electronically screen

Manual ScreenWithout injury

Manual Screen

Random 25% sample also manual review, and 43 sample found 15 AEs,

so author estimate in screened negative

discharge summaries has 34% AEs. All 251 sample need manual review.

ResultsResults

Table 3, Table 4, Table 5 show some Table 3, Table 4, Table 5 show some detail information for AE categories.detail information for AE categories.

Those result have statistic meaning for Those result have statistic meaning for improve medical care.improve medical care.

Some admissions had more than one AE Some admissions had more than one AE within the chart.within the chart.

ResultsResultsPossible AE

No AE and Screened negative

discharge summaries

discharge summaries with trigger word

discharge summaries without trigger word

Possible AE

DiscussionDiscussion

Discharge summaries contain useful Discharge summaries contain useful information for detecting AEs.information for detecting AEs.

In this study 45% patients experienced In this study 45% patients experienced AEs, higher than prior studies.AEs, higher than prior studies.( 191 of 424 ) ( 119 of 1052 )( 191 of 424 ) ( 119 of 1052 )

This screening tool should be improved.This screening tool should be improved.

DiscussionDiscussion

LimitationsLimitations：：1. Discharge summaries selected form 1. Discharge summaries selected form only one hospital.only one hospital.

2. Search only discharge summaries, 2. Search only discharge summaries, there are other documents.there are other documents.

3. Physician review problem.3. Physician review problem.

4. Differences in cohort1 and cohort2. 4. Differences in cohort1 and cohort2.

ConclusionsConclusions

Electronic screening discharge summaries Electronic screening discharge summaries for detected AEs is feasible.for detected AEs is feasible.

Combination of electronic screening and Combination of electronic screening and manual review can improve specificity.manual review can improve specificity.

NLP techniques may improve specificity NLP techniques may improve specificity enough not to require manual review.enough not to require manual review.

My observationMy observation

This study maybe is the first study to use This study maybe is the first study to use discharge summaries.discharge summaries.

Use electronic screening to detected AEs Use electronic screening to detected AEs is more efficiency than traditional manual is more efficiency than traditional manual work.work.

There are still many medical documents There are still many medical documents that may contain rich information.that may contain rich information.

My observationMy observation

The experiment has some “drawback”, but The experiment has some “drawback”, but author also “honest”.author also “honest”.

Define “adverse events” still problem.Define “adverse events” still problem.

Useful application without tough Useful application without tough technique.technique.

Thanks for your attention Thanks for your attention