Key result
The Patient Safety Indicator algorithm missed postoperative respiratory failure in 27% of elective cases, with 55% of these false negatives lacking ventilation or intubation codes.
Observational (n=125)
The Patient Safety Indicator algorithm often misses postoperative respiratory failure events, and improved ventilation/intubation coding would have a greater impact on case identification than adding new ICD-9-CM codes.
May underestimate postoperative respiratory failure in quality metrics; leaves open whether targeted coding refinements improve detection accuracy.
The Patient Safety Indicator postoperative respiratory failure (PRF) flags cases using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for acute respiratory failure or mechanical ventilation/intubation. The authors examined how frequently PRF missed events and ways to improve event identification. A total of 125 high-risk unflagged cases were selected based on predicted probability and presence of clinically relevant codes. False-negative (FN) proportion and associated reasons were determined through chart review, and likelihood ratios (LRs) of associated codes were calculated. In all, 27% of elective cases were FNs; 55% of FNs lacked ventilation/intubation codes. "Respiratory arrest," 799.1, had the highest LR (5.4) but occurred in only 8% of FNs. All other individual diagnostic or procedure codes had relatively low LRs (≤ 3.1), despite occurring in up to 36% of FNs. Among high-risk cases, the PRF algorithm often missed events. Improved ventilation/intubation coding will have more of an impact on case identification than adding ICD-9-CM codes to the algorithm.
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Borzecki et al. (2012) conducted an observational in Postoperative respiratory failure (n=125). Patient Safety Indicator postoperative respiratory failure (PRF) algorithm was evaluated on False-negative proportion of elective cases. The Patient Safety Indicator algorithm missed postoperative respiratory failure in 27% of elective cases, with 55% of these false negatives lacking ventilation or intubation codes.
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