Electronically Screening Discharge Summaries for Adverse Medical Events Harvey J. Murff, MD, MPH, Alan J. Forster, MD, MSc...
outline <ul><li>Introduction </li></ul><ul><li>Methods </li></ul><ul><li>Results </li></ul><ul><li>Discussion </li></ul><u...
Introduction <ul><li>Adverse events (AEs) defined : an injury caused by medical management rather than patient’s underlyin...
Introduction <ul><li>The key goal in health care quality improvement. </li></ul><ul><li>How to measure it? </li></ul><ul><...
Methods <ul><li>Sample selection this hospital policy requests physicians complete discharge summaries within 30 days, tha...
Methods <ul><li>Harvard Medical Practice Study (MPS)  a two-step review process with nurse and physician. </li></ul><ul><l...
Methods <ul><li>Trigger words: the words related to AEs. </li></ul>
Trigger word electronically screen Manual Screen Without injury Manual Screen Random 25% sample also manual review, and 43...
Results <ul><li>Table 3, Table 4, Table 5 show some detail information for AE categories. </li></ul><ul><li>Those result h...
Results Possible AE No AE and  Screened negative discharge summaries discharge summaries with trigger word discharge summa...
Discussion <ul><li>Discharge summaries contain useful information for detecting AEs. </li></ul><ul><li>In this study 45% p...
Discussion <ul><li>Limitations : 1. Discharge summaries selected form only one hospital. 2. Search only discharge summarie...
Conclusions <ul><li>Electronic screening discharge summaries for detected AEs is feasible. </li></ul><ul><li>Combination o...
My observation <ul><li>This study maybe is the first study to use discharge summaries. </li></ul><ul><li>Use electronic sc...
My observation <ul><li>The experiment has some “drawback”, but author also “honest”. </li></ul><ul><li>Define “adverse eve...
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951023 Electronically Screening Discharge Summaries For Adverse Medical Events

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951023 Electronically Screening Discharge Summaries For Adverse Medical Events

  1. 1. Electronically Screening Discharge Summaries for Adverse Medical Events Harvey J. Murff, MD, MPH, Alan J. Forster, MD, MSc, Josh F. Peterson, MD, MPH, Julie M. Fiskio, BA, Heather L. Heiman, MD, David W. Bates, MD, MSc Journal of the American Medical Informatics Association 2003 S.Y. Song 2006/10/23
  2. 2. outline <ul><li>Introduction </li></ul><ul><li>Methods </li></ul><ul><li>Results </li></ul><ul><li>Discussion </li></ul><ul><li>Conclusions </li></ul><ul><li>My observation </li></ul>
  3. 3. Introduction <ul><li>Adverse events (AEs) defined : an injury caused by medical management rather than patient’s underlying condition. </li></ul><ul><li>In the United States some study show the rate of AEs ranging from 2.9% to 16.6%. </li></ul><ul><li>Estimates the Taiwan area, the death population cause by AEs approximately is 6,000 to 20,000 every year. (2003 醫策會 ) </li></ul>
  4. 4. Introduction <ul><li>The key goal in health care quality improvement. </li></ul><ul><li>How to measure it? </li></ul><ul><li>Manual review or computerized screening? </li></ul>
  5. 5. Methods <ul><li>Sample selection this hospital policy requests physicians complete discharge summaries within 30 days, that patients hospitalized more than 72 hours. </li></ul><ul><li>Some medical records “lack” some information will banish. </li></ul><ul><li>2 cohort. </li></ul>
  6. 6. Methods <ul><li>Harvard Medical Practice Study (MPS) a two-step review process with nurse and physician. </li></ul><ul><li>Adverse events categories select. 18 categories reduce to 11 categories. </li></ul><ul><li>Search only section “ hospital course ” of discharge summaries. </li></ul>
  7. 7. Methods <ul><li>Trigger words: the words related to AEs. </li></ul>
  8. 8. Trigger word electronically screen Manual Screen Without injury Manual Screen Random 25% sample also manual review, and 43 sample found 15 AEs, so author estimate in screened negative discharge summaries has 34% AEs. All 251 sample need manual review.
  9. 9. Results <ul><li>Table 3, Table 4, Table 5 show some detail information for AE categories. </li></ul><ul><li>Those result have statistic meaning for improve medical care. </li></ul><ul><li>Some admissions had more than one AE within the chart. </li></ul>
  10. 10. Results Possible AE No AE and Screened negative discharge summaries discharge summaries with trigger word discharge summaries without trigger word Possible AE
  11. 11. Discussion <ul><li>Discharge summaries contain useful information for detecting AEs. </li></ul><ul><li>In this study 45% patients experienced AEs, higher than prior studies. ( 191 of 424 ) ( 119 of 1052 ) </li></ul><ul><li>This screening tool should be improved. </li></ul>
  12. 12. Discussion <ul><li>Limitations : 1. Discharge summaries selected form only one hospital. 2. Search only discharge summaries, there are other documents. 3. Physician review problem. 4. Differences in cohort1 and cohort2. </li></ul>
  13. 13. Conclusions <ul><li>Electronic screening discharge summaries for detected AEs is feasible. </li></ul><ul><li>Combination of electronic screening and manual review can improve specificity. </li></ul><ul><li>NLP techniques may improve specificity enough not to require manual review. </li></ul>
  14. 14. My observation <ul><li>This study maybe is the first study to use discharge summaries. </li></ul><ul><li>Use electronic screening to detected AEs is more efficiency than traditional manual work. </li></ul><ul><li>There are still many medical documents that may contain rich information. </li></ul>
  15. 15. My observation <ul><li>The experiment has some “drawback”, but author also “honest”. </li></ul><ul><li>Define “adverse events” still problem. </li></ul><ul><li>Useful application without tough technique. </li></ul>
  16. 16. Thanks for your attention

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