Subject(s)
Carcinoma, Non-Small-Cell Lung/therapy , Carcinoma, Small Cell/therapy , Clinical Trials as Topic , Lung Neoplasms/therapy , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Small Cell/mortality , Carcinoma, Small Cell/pathology , Combined Modality Therapy , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Neoplasm Metastasis/prevention & control , Neoplasms, Second Primary/prevention & control , United StatesSubject(s)
Clinical Trials as Topic , Neoplasms/therapy , Breast Neoplasms/therapy , Clinical Protocols , Endometrial Neoplasms/drug therapy , Estrogen Replacement Therapy , Female , Gastrointestinal Neoplasms/therapy , Humans , Male , Multiple Myeloma/therapy , Neoplasms/pathology , Ovarian Neoplasms/drug therapy , Respiratory Tract Neoplasms/therapy , United StatesABSTRACT
OBJECTIVE: To investigate the sensitivity and efficiency of medical record review for detecting adverse occurrences. DESIGN: A prospective observational study. Adverse occurrences were defined broadly as events that caused or had potential to cause adverse patient outcomes. Between August 1, 1990 and March 1, 1991 a research nurse reviewed written medical records and attended nursing morning report. SETTING: A university hospital. PATIENTS: Inpatients on two general medical wards and the medical and cardiovascular intensive care units. RESULTS: There were 317 occurrences identified (0.2 per patient day): 56% were medication related, 20% were new medical conditions, 11% were procedure complications, 5% were patient dissatisfaction related, 4% were equipment related, and 3% were accidents. Review of physician progress notes was the most sensitive means of detecting new conditions (sensitivity 73%), procedure complications (sensitivity 100%), equipment-related occurrences (sensitivity 71%), and adverse drug reactions (sensitivity 89%). Review of nursing notes was the most sensitive means of detecting patient dissatisfaction (sensitivity 69%) and accident-related occurrences (sensitivity 100%). Passive reporting through incident reports identified only 9% of all adverse occurrences. Surveillance was time-consuming: concurrent review of all written sources in a 250-bed hospital would require 5.5 technicians. CONCLUSIONS: Surveillance for adverse occurrences is expensive. If selected adverse occurrences were identified as being important for quality improvement, surveillance could be focused efficiently on limited sources. The number of adverse occurrences discovered by surveillance will be heavily dependent on the choice of data source (physician progress notes, nursing notes, etc.). Comparisons among hospitals can be made only when systems for detection have similar validity.
Subject(s)
Hospitals, University/standards , Iatrogenic Disease/epidemiology , Outcome and Process Assessment, Health Care/organization & administration , Accidents/statistics & numerical data , Data Collection , Evaluation Studies as Topic , Hospital Bed Capacity, 500 and over , Humans , Iowa/epidemiology , Medical Records/statistics & numerical data , Medication Errors/statistics & numerical data , Outcome and Process Assessment, Health Care/statistics & numerical data , Reproducibility of ResultsABSTRACT
OBJECTIVE: To determine the importance of procedure-related complications on a general medical service. DESIGN: A retrospective cohort study with one-to-one matching. Complications were identified through chart review by nurse-technicians using standard definitions. SETTING: The internal medicine service of a 900-bed university hospital. PATIENTS: One hundred seven cases with noninfectious, procedure-related complications and 107 closely matched controls who underwent the same procedures without complication. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The mortality rate was 28% for cases compared with 11% for controls, resulting in an excess mortality rate of 17% (p = 0.02). Cases who survived to discharge had an excess length of stay of seven days (p = 0.001). The excess cost per case was $12,913. Importantly, median reimbursement was only $2,064 higher for cases than for controls. Adjusting for age and APACHE II (severity of illness) score, procedure-related complications were associated with a 3.4-fold increase in the relative risk of in-hospital mortality (95% CI: 1.5 to 7.7). Surveillance data were useful in directing quality improvement activities that resulted in a 66% reduction in the rate of pneumothorax following thoracentesis. CONCLUSIONS: Procedure-related complications were associated with prolonged and expensive hospitalization and were a marker for patients at high risk for in-hospital mortality. Programs to reduce complications on the general medical service have an enormous potential to benefit both patients and hospitals.
Subject(s)
Therapeutics/adverse effects , Cause of Death , Cohort Studies , Humans , Inpatients , Iowa/epidemiology , Morbidity , Mortality , Pneumothorax/etiology , Punctures/adverse effects , Retrospective StudiesABSTRACT
Two anuric infants had recurrent hyponatremia during chronic peritoneal dialysis (PD). This occurred because at normal serum sodium concentrations ([Na]), Na losses from ultrafiltration (UF) were greater than the Na ingested from infant formula. Hyponatremia was corrected with increased oral Na intake or with increased dialysis solution [Na]. Anuric infants undergoing PD have hyponatremia because of their high UF requirements/body weight and the low Na content of proprietary infant formulas.
