Trigger Tools May Detect Adverse Events Following Surgery

Patients who suffer pulmonary embolism or deep-vein thrombosis (PE/DVT) within 30 days of an outpatient surgery, and an emergency department visit within 21 days, are most likely to suffer other adverse events, according to a new study.

Three other so-called triggers - hospital admission within 30 days of the surgery, hospital admission for longer than 24 hours, and certain intervention procedures or reoperation within 30 days - were much less precise in identifying a likely adverse event.

Dr. Amy Helwig, of the Agency for Healthcare Research and Quality, and fellow researchers ran all five triggers on electronic medical records data from patients who underwent outpatient surgeries at participating institutions. As a result, 6,688 of 17,492 records were flagged that had at least 1 trigger.

Nurses looked at each flagged record to identify adverse events occurring within 30 days of the outpatient surgery. The percent of cases flagged ranged from 1.1 percent to 22 percent, depending on the trigger.

The PE/DVT trigger, though flagging the smallest number of cases (189, or 1.1 percent), had the highest positive predictive value (PPV), 62 percent for any adverse event.

The other triggers' PPVs for any adverse event ranged from 6 percent (the procedure trigger, which flagged 1,135 cases) to 23 percent (the hospital admission trigger, which flagged 3,846 cases).

The researchers obtained de-identified patient data from three health care systems interested in the use of triggers. Eligible adults had surgery during 2007 and had at least one clinical note within 6 months of the surgery.

“Triggers may be useful in identifying a narrow set of surgeries for further review to determine if a surgical adverse event occurred, complementing existing tools and initiatives used to detect adverse events,” the authors write. “Improved detection of adverse events in outpatient surgery should help target potential areas for quality improvement.”

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