Journal of evaluation in clinical practice
-
Multicenter Study
Accuracy of administrative coding in identifying hip and knee primary replacements and revisions.
Hospital discharge notes can be used to identify rates of revisions in hip and knee arthroplasty surgeries if such administrative codes are accurate. In order to trust the data taken from the hospital discharge abstracts it is important to assess their reliability. The purpose of this study is to evaluate the accuracy of the administrative coding used in measuring revision rates for total hip and knee arthroplasty. ⋯ This study demonstrates that ICD-9CM and ICD-10CM codes can be used accurately when analysing hip and knee arthroplasty. This study was conducted in a large tertiary academic centre where a significant number of records analysts are employed; therefore, there should be little inter-hospital error. These results should help researchers understand the potential accuracy of classification for these procedures as part of an audit or quality assurance project.
-
Multicenter Study
A new perspective on blame culture: an experimental study.
Recently, a range of different institutions worldwide has identified the 'culture of blame' and the fear of being punished as the principal reasons for the lack of medical error reporting and, consequently, of their reiteration and of the poor quality of patient care. Despite much theoretical debate, there currently exist no experimental studies that directly investigate the presence and pervasiveness of the blame and punishment culture in health care contexts. In order to document empirical evidence for this culture in medicine and nursing, we conducted an experimental study asking physicians and nurses to express their fear of blame or punishment in the context of having made an error that would cause: (i) no; (ii) mild; (iii) severe consequences; or (iv) the death of the patient. ⋯ Given the relevance of these factors in medical error reporting and the evidence that they are so deep-seated not only in senior professionals, but also in students, we argue that an educational approach, together with an organization-based intervention, is desirable to shape cultural attitudes of health care providers in the direction of a 'safety culture'.