Asking residents about adverse events in a computer dialogue: how accurate are they?

BACKGROUND: Although retrospective identification of adverse events is time-consuming, whether they are present and/or expected is often readily apparent to providers during the provision of care. METHODS: A computer program to flag admissions with possible adverse events was developed. Readmissions to the hospital within 31 days and admissions including more than one visit to the operating room (OR) were flagged. For surgical site infections, all admissions--including a visit to the OR--were flagged, but only a sample was evaluated in the reliability assessment. Residents in an urban, tertiary care hospital were questioned when inputting computerized discharge orders regarding adverse events among 391 cases sampled from 6,813 admissions for a two-month period. RESULTS: For the 228 readmissions (3.3% of all admissions) identified by the computer program, resident responses had a sensitivity of 57% and a specificity of 73% in detecting an unexpected readmission (nurse responses, 96% and 91%). For the 79 patients with a return to the OR, the residents' responses had a sensitivity of 86% and a specificity of 84% for detecting an unexpected return (versus 75% and 98% for the nurses' responses). For the 209 patients with an OR visit, the sensitivity and specificity for a surgical site infection were 85% and 98% for the residents and 54% and 99% for the nurses. DISCUSSION: Information systems can be used to screen for adverse events and to ask providers whether adverse events are unexpected, although the reliability of this approach is likely to vary by event type.

Trends in the use of radiology with inpatients: what has changed in a decade?

OBJECTIVE: Our goal was to evaluate trends in the use of radiology with inpatients in the 10-year period of 1984-1993. MATERIALS AND METHODS: We retrospectively reviewed administrative data from a 751-bed, tertiary care hospital between October 1, 1983, and September 30, 1993 (Fiscal years 1984-1993). We coded each study by imaging technique: CT, MR imaging, sonography, nuclear medicine, or conventional studies (plain films and fluoroscopy). Echocardiography, cardiac catheterization, and angioplasty procedures were omitted. The number of admissions per year was adjusted for severity of disease (case-mix-adjusted admission [CMA]). We used relative value units to evaluate workload changes during the study period. We assessed significance of trends using linear regression analysis. RESULTS: The total number of imaging studies per CMA decreased during the study period (p = .0001). This was due to a decrease in the number of conventional studies (p = .0001) and sonograms per CMA (p = .02), despite significant increases in the numbers of CT (p = .005) and MR imaging (p = .0001) studies per CMA. No significant change existed in the number of nuclear medicine studies per CMA (p = .11). The global, professional, and technical relative value units per CMA rose during the latter half of the study. CONCLUSION: The overall number of imaging studies per CMA decreased during the decade, despite a significant rise in the use of CT and MR imaging, suggesting that these new imaging techniques are replacing older ones. To control further increases in overall imaging costs, priority should be placed on understanding the patterns of use for CT and MR imaging techniques and curbing their inappropriate use.