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Submitted on August 8, 2002
Accepted on January 29, 2003
Affiliation of the authors: 1 Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN; 2 University of Ottawa, Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada; 3 Division of General Internal Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
* To whom correspondence should be addressed.
Objective Detecting adverse events is pivotal for measuring and improving medical safety yet current techniques discourage routine screening. We hypothesized that discharge summaries would include information on adverse events and developed and evaluated an electronic method for screening medical discharge summaries for adverse events.
Design A cohort including 424 randomly selected admissions to the medical services of an academic medical center between January and July 2000. We developed a computerized screening tool that searched free text discharge summaries for trigger words representing possible adverse events.
Measurements All discharge summaries with a trigger word present underwent chart review by two independent physician reviewers. The presence of adverse events was assessed using structured implicit judgment. A random sample of discharge summaries without trigger words was also reviewed.
Results Fifty-nine percent (251/424) of the discharge summaries contained trigger words. Based on discharge summary review, 44.8% (327/730) of the alerted trigger words indicated a possible adverse event. After medical record review, the tool detected 131 adverse events. The sensitivity and specificity of the screening tool were 69% and 48%, respectively. The positive predictive value of the tool was 52%.
Conclusion Medical discharge summaries contain information regarding adverse events. Electronic screening of discharge summaries for adverse events using keyword searches is feasible but thus far has poor specificity. Nonetheless, computerized clinical narrative screening methods could potentially offer researchers and quality managers a means to routinely detect adverse events.
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