Phenotyping for patient safety: algorithm development for electronic health record based automated adverse event and medical error detection in neonatal intensive care

J Am Med Inform Assoc. 2014 Sep-Oct;21(5):776-84. doi: 10.1136/amiajnl-2013-001914. Epub 2014 Jan 8.


Background: Although electronic health records (EHRs) have the potential to provide a foundation for quality and safety algorithms, few studies have measured their impact on automated adverse event (AE) and medical error (ME) detection within the neonatal intensive care unit (NICU) environment.

Objective: This paper presents two phenotyping AE and ME detection algorithms (ie, IV infiltrations, narcotic medication oversedation and dosing errors) and describes manual annotation of airway management and medication/fluid AEs from NICU EHRs.

Methods: From 753 NICU patient EHRs from 2011, we developed two automatic AE/ME detection algorithms, and manually annotated 11 classes of AEs in 3263 clinical notes. Performance of the automatic AE/ME detection algorithms was compared to trigger tool and voluntary incident reporting results. AEs in clinical notes were double annotated and consensus achieved under neonatologist supervision. Sensitivity, positive predictive value (PPV), and specificity are reported.

Results: Twelve severe IV infiltrates were detected. The algorithm identified one more infiltrate than the trigger tool and eight more than incident reporting. One narcotic oversedation was detected demonstrating 100% agreement with the trigger tool. Additionally, 17 narcotic medication MEs were detected, an increase of 16 cases over voluntary incident reporting.

Conclusions: Automated AE/ME detection algorithms provide higher sensitivity and PPV than currently used trigger tools or voluntary incident-reporting systems, including identification of potential dosing and frequency errors that current methods are unequipped to detect.

Keywords: Electronic Health Record (EHR); Natural Language Processing (NLP); Neonatal Intensive Care Unit (NICU); automatic adverse event and medical error detection; patient safety; phenotyping.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Airway Management / adverse effects*
  • Algorithms*
  • Electronic Health Records*
  • Humans
  • Infant, Newborn
  • Infusions, Intravenous / adverse effects*
  • Intensive Care Units, Neonatal
  • Medical Errors / adverse effects*
  • Medical Errors / prevention & control
  • Medication Errors / adverse effects
  • Patient Safety*
  • Predictive Value of Tests
  • Risk Management
  • Sensitivity and Specificity