A validade dos indicadores de segurança do paciente (ISP) da Agency for Healthcare Research and Quality foi estabelecida nos EUA e no Canadá. No entanto, esses indicadores também são usados para benchmarking hospitalar e comparações entre países em outras nações com diferentes configurações de cuidados de saúde e sistemas de codificação, bem como sinalizadores de presença na admissão (present on admission - POA) ausentes nos dados administrativos. Este estudo procurou avaliar e comparar de forma abrangente a validade de 16 ISP na Suíça, onde eles não foram aplicados anteriormente. Foi feita uma revisão de prontuários usando dados de prontuários administrativos e eletrônicos de nove hospitais suíços. Sete revisores independentes avaliaram 1.245 casos em vários hospitais usando dados retrospectivos dos anos de 2014-18. Verdadeiros positivos, falsos positivos, valores preditivos positivos (VPP) e motivos para classificação incorreta foram comparados em todos os ISP investigados, e a qualidade da documentação dos ISP foi examinada. Os ISPs 6 (pneumotórax iatrogênico), 10 (lesão renal aguda pós-operatória), 11 (insuficiência respiratória pós-operatória), 13 (sepse pós-operatória), 14 (deiscência da ferida), 17 (trauma no nascimento) e 18 e 19 (trauma obstétrico com ou sem instrumento) apresentaram altos VPPs (intervalo: 90-99%) e não foram fortemente influenciados pela falta de informações de POA. Em contraste, os ISP 3 (lesão por pressão), 5 (item cirúrgico retido), 7 (infecção de corrente sanguínea associada a cateter venoso central), 8 (queda com fratura de quadril) e 15 (punção/laceração acidental) apresentaram baixos VPP (intervalo: 18-49%). No caso dos ISP 3, 8 e 12 (embolia/trombose perioperatória), os baixos VPP foram em grande parte devido à falta de informações de POA. Além disso, verificou-se que a documentação do ISP 3 nas instruções de alta poderia ser melhorada. Encontramos grandes diferenças de validade entre os 16 ISPs na Suíça. Esses resultados podem orientar os formuladores de políticas na Suíça e sistemas de saúde comparáveis na seleção e priorização de ISP adequados para iniciativas de qualidade. Além disso, a introdução nacional de um sinalizador de POA permitiria a inclusão de ISPs adicionais no monitoramento da qualidade.
The validity of the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) has been established in the USA and Canada. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different health-care settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied. We performed a medical record review using administrative and electronic medical record data from nine Swiss hospitals. Seven independent reviewers evaluated 1245 cases at various hospitals using retrospective data from the years 2014-18. True positives, false positives, positive predictive values (PPVs), and reasons for misclassification were compared across all investigated PSIs, and the documentation quality of the PSIs was examined. PSIs 6 (iatrogenic pneumothorax), 10 (postoperative acute kidney injury), 11 (postoperative respiratory failure), 13 (postoperative sepsis), 14 (wound dehiscence), 17 (birth trauma), and 18 and 19 (obstetric trauma with or without instrument) showed high PPVs (range: 90-99%) and were not strongly influenced by missing POA information. In contrast, PSIs 3 (pressure ulcer), 5 (retained surgical item), 7 (central venous catheter-related bloodstream infection), 8 (fall with hip fracture), and 15 (accidental puncture/laceration) showed low PPVs (range: 18-49%). In the case of PSIs 3, 8, and 12 (perioperative embolism/thrombosis), the low PPVs were largely due to the lack of POA information. Additionally, it was found that the documentation of PSI 3 in discharge letters could be improved. We found large differences in validity across the 16 PSIs in Switzerland. These results can guide policymakers in Switzerland and comparable health-care systems in selecting and prioritizing suitable PSIs for quality initiatives. Furthermore, the national introduction of a POA flag would allow for the inclusion of additional PSIs in quality monitoring.
The validity of the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) has been established in the USA and Canada. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different health-care settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied. We performed a medical record review using administrative and electronic medical record data from nine Swiss hospitals. Seven independent reviewers evaluated 1245 cases at various hospitals using retrospective data from the years 2014-18. True positives, false positives, positive predictive values (PPVs), and reasons for misclassification were compared across all investigated PSIs, and the documentation quality of the PSIs was examined. PSIs 6 (iatrogenic pneumothorax), 10 (postoperative acute kidney injury), 11 (postoperative respiratory failure), 13 (postoperative sepsis), 14 (wound dehiscence), 17 (birth trauma), and 18 and 19 (obstetric trauma with or without instrument) showed high PPVs (range: 90-99%) and were not strongly influenced by missing POA information. In contrast, PSIs 3 (pressure ulcer), 5 (retained surgical item), 7 (central venous catheter-related bloodstream infection), 8 (fall with hip fracture), and 15 (accidental puncture/laceration) showed low PPVs (range: 18-49%). In the case of PSIs 3, 8, and 12 (perioperative embolism/thrombosis), the low PPVs were largely due to the lack of POA information. Additionally, it was found that the documentation of PSI 3 in discharge letters could be improved. We found large differences in validity across the 16 PSIs in Switzerland. These results can guide policymakers in Switzerland and comparable health-care systems in selecting and prioritizing suitable PSIs for quality initiatives. Furthermore, the national introduction of a POA flag would allow for the inclusion of additional PSIs in quality monitoring.
