• Nicole Fox, Rebecca Willcutt, Adrienne Elberfeld, John Porter, and Anthony J Mazzarelli.
• Clinical Documentation Improvement Program, Department of Surgery, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States. Electronic address: fox-nicole@cooperhealth.edu.
• Injury. 2017 Sep 1; 48 (9): 1994-1998.

BackgroundThe Agency for Health Care Research and Quality (AHRQ) developed patient safety indicators (PSIs) to identify events with a high likelihood of representing medical error. The purpose of this study was to validate PSIs attributed to trauma surgeons and compare validated PSIs to performance improvement (PI) and morbidity and mortality (M&M) data. We hypothesized that PSIs are not an indicator of quality of care in trauma.MethodsPSI's attributed to trauma surgeons (n=9) at our institution were reviewed (Jan-Dec 2015). An initial review was conducted to ensure they met inclusion and exclusion criteria (valid). "Valid" PSIs were distributed to the trauma division for secondary review.Results48 PSIs were identified (17.2 per 1000 cases) during the study period. 19 were false positives yielding a positive predictive value of 60% (95% CI 45-74%). False positive PSIs were the result of coding error (78%), present on admission status (17%) and documentation error (5%). Valid PSIs (n=29) were further analyzed. The most common were post-op PE/DVT (n=14), failure to rescue (n=6) and accidental puncture/laceration (n=3). 60% of patients with a post-op PE/DVT were started on chemoprophylaxis on admission and 40% had significant intracranial hemorrhage; all were deemed non-preventable through trauma PI. All deaths considered failure to rescue were classified as expected mortalities during M&M review. Although not clinically significant, all cases of accidental puncture/laceration (10% of valid PSIs) represented opportunities for improvement.ConclusionOverall, PSIs have low validity and do not reflect quality of care in trauma.Copyright © 2017 Elsevier Ltd. All rights reserved.

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