Evaluation of an electronic health record structured discharge summary to provide real time adverse event reporting in thoracic surgery

BMJ Qual Saf. 2019 Apr;28(4):310-316. doi: 10.1136/bmjqs-2018-008090. Epub 2019 Jan 18.


Background: The reporting of adverse events (AE) remains an important part of quality improvement in thoracic surgery. The best methodology for AE reporting in surgery is unclear. An AE reporting system using an electronic discharge summary with embedded data collection fields, specifying surgical procedure and complications, was developed. The data are automatically transferred daily to a web-based reporting system.

Methods: We determined the accuracy and sustainability of this electronic real time data collection system (ERD) by comparing the completeness of record capture on procedures and complications with coded discharge data (administrative data), and with the standard of chart audit at two intervals. All surgical procedures performed for 2 consecutive months at initiation (Ti) and 1 year later (T1yr) were audited by an objective trained abstractor. A second abstractor audited 10% of the charts.

Results: The ERD captured 71/72 (99%) of charts at Ti and 56/65 (86%) at T1yr. Comparing the presence/absence of complications between ERD and chart audit demonstrated at Ti a high sensitivity and specificity, positive predictive value (PPV) of 95.5%, negative predictive value (NPV) of 93.9% with a kappa of 0.872 (95% CI 0.750 to 0.994), and at T1yr a sensitivity, specificity, PPV and NPV of 100% with a kappa of 1.0 (95% CI 1.0). Comparing the presence/absence of complications between administrative data and chart audit at Ti demonstrated a low sensitivity, high specificity and a kappa of 0.471 (95% CI 0.256 to 0.686), and at T1yr a low sensitivity, high specificity of 85% and a kappa of 0.479 (95% CI 0.245 to 0.714).

Conclusions: We found that the ERD can provide accurate real time AE reporting in thoracic surgery, has advantages over previous reporting methodologies and is an alternative system for surgical clinical teams developing AE reporting systems.

Keywords: adverse events; patient safety; quality improvement; quality improvement methodologies; surgery.

Publication types

  • Evaluation Study

MeSH terms

  • Documentation* / methods
  • Electronic Health Records*
  • Humans
  • Medical Errors / classification
  • Medical Errors / statistics & numerical data*
  • Outcome Assessment, Health Care
  • Patient Safety
  • Quality Assurance, Health Care
  • Quality Improvement
  • Safety Management
  • Thoracic Surgical Procedures / adverse effects*