Key result
Hospital processes of care were comparable between accidental puncture/laceration cases and controls, while differences in wound dehiscence cases were driven by underlying surgical problems.
Why the study?
Do AHRQ Patient Safety Indicators (Postoperative Wound Dehiscence and Accidental Puncture or Laceration) reflect problems with hospital processes of care?
Case-Control (n=380)
Do AHRQ Patient Safety Indicators (Postoperative Wound Dehiscence and Accidental Puncture or Laceration) reflect problems with hospital processes of care?
Answers are grounded in this paper and cite their sources.
AHRQ Patient Safety Indicators for postoperative wound dehiscence and accidental puncture/laceration may reflect underlying surgical complexity rather than true shortfalls in quality of care.
This study examines whether Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) Postoperative Wound Dehiscence (PWD) and Accidental Puncture or Laceration (APL) events reflect problems with hospital processes of care (POC). The authors randomly selected 112 PSI-flagged PWD/APL discharges from 2002-2007 VA administrative data, identified true cases using chart review, and matched cases with controls. This yielded a total of 95 case-control pairs per PSI. Patient information and clinical processes on each case-control pair were abstracted from the electronic medical record (EMR). Although PWD cases and controls differed on incision and closure types, APL cases and controls were comparable in examined processes. Further exploration of the process differences between PWD cases and controls indicated that they were primarily caused by patients' underlying surgical problems rather than quality of care shortfalls. Documentation of POC was frequently missing in EMRs. Future studies should combine EMR review with alternative approaches, such as direct observation, to better assess POC.
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Chen et al. (2012) conducted a case-control in Postoperative Wound Dehiscence and Accidental Puncture or Laceration (n=380). Hospital processes of care vs. Controls without PSI events was evaluated on Differences in hospital processes of care. Hospital processes of care were comparable between accidental puncture/laceration cases and controls, while differences in wound dehiscence cases were driven by underlying surgical problems.
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