Detecting adverse events in surgery: comparing events detected by the Veterans Health Administration Surgical Quality Improvement Program and the Patient Safety Indicators

Am J Surg. 2014 Apr;207(4):584-95. doi: 10.1016/j.amjsurg.2013.08.031. Epub 2013 Nov 7.


Background: The Patient Safety Indicators (PSIs) use administrative data to screen for select adverse events (AEs). In this study, VA Surgical Quality Improvement Program (VASQIP) chart review data were used as the gold standard to measure the criterion validity of 5 surgical PSIs. Independent chart review was also used to determine reasons for PSI errors.

Methods: The sensitivity, specificity, and positive predictive value of PSI software version 4.1a were calculated among Veterans Health Administration hospitalizations (2003-2007) reviewed by VASQIP (n = 268,771). Nurses re-reviewed a sample of hospitalizations for which PSI and VASQIP AE detection disagreed.

Results: Sensitivities ranged from 31% to 68%, specificities from 99.1% to 99.8%, and positive predictive values from 31% to 72%. Reviewers found that coding errors accounted for some PSI-VASQIP disagreement; some disagreement was also the result of differences in AE definitions.

Conclusions: These results suggest that the PSIs have moderate criterion validity; however, some surgical PSIs detect different AEs than VASQIP. Future research should explore using both methods to evaluate surgical quality.

Keywords: Administrative data; Adverse surgical events; Patient Safety Indicators; VA Surgical Quality Improvement Program; Veterans Health Administration.

Publication types

  • Comparative Study

MeSH terms

  • Hospital Records
  • Hospitals, Veterans*
  • Humans
  • Incidence
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Predictive Value of Tests
  • Quality Assurance, Health Care / methods*
  • Quality Improvement*
  • Surgical Procedures, Operative / adverse effects
  • United States / epidemiology
  • United States Department of Veterans Affairs*