scholarly journals Risk of serious spinal adverse events associated with epidural corticosteroid injections in the Medicare population

2020 ◽  
pp. rapm-2020-101778
Author(s):  
Efe Eworuke ◽  
Leah Crisafi ◽  
Jiemin Liao ◽  
Sandia Akhtar ◽  
Martha Van Clief ◽  
...  
Keyword(s):  
Adverse Events ◽  
Medical Record ◽  
Medical Records ◽  
Score Test ◽  
P Value ◽  
Spinal Level ◽  
Medicare Population ◽  
Event Rates ◽  
Record Review ◽  
Corticosteroid Injections

BackgroundEpidural corticosteroid injections (ESIs) are widely performed and have an unquantified risk of serious spinal adverse events (SSAEs). We sought to determine the rate of SSAEs following ESI and to compare the rates by spinal level, injection approach and corticosteroid formulation.MethodsWe included patients enrolled in Medicare parts A and B who had an ESI between 1 January 2009 and 30 September 2015. We identified potential cases as patients with spine-related diagnoses within 3 days after the first eligible ESI. Event categorization as probable, possible or non-case was based on review of medical records. The rates of probable and possible cases were expressed per 1 000 000 patients overall, and by spinal level, injection approach and corticosteroid formulation. A score test was used to compare these rates.ResultsWe identified 1 355 957 eligible ESIs during the study period. Of the 110 potential cases, 43 were selected for medical record review and 11 were categorized as probable, yielding a rate of 8.1 per 1 000 000 patients (95% CI 4.5 to 14.5). Risk of SSAEs was statistically higher with cervical/thoracic injections (29.4, 95% CI 12.5 to 68.8) compared with lumbar/sacral injections (5.1, 95% CI 2.3 to 11.0) (p value 0.001). Event rates for lumbar/sacral non-transforaminal injections was 8.8 (95% CI 4.0 to 19.1). Event rates for particulate (7.5, 95% CI 3.9 to 14.2) and non-particulate formulations (13.1, 95% CI 3.6 to 47.9) appeared similar (p value 0.47).ConclusionBetween 2009 and 2015, rates of SSAEs following ESI in the Medicare population were low. Patients receiving cervical/thoracic ESIs were at higher risk of SSAE than those receiving lumbar/sacral ESIs. Event rates were similar for each corticosteroid formulation.

scholarly journals Variation between hospitals and reviewers in detection of adverse events identified through medical record review in Korea

2020 ◽  
Vol 32 (8) ◽  
pp. 495-501
Author(s):  
Sukyeong Kim ◽  
Ho Gyun Shin ◽  
A E Jeong Jo ◽  
Ari Min ◽  
Minsu Ock ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Medical Record ◽  
Medical Records ◽  
Third Party ◽  
Medical Record Review ◽  
Screening Criteria ◽  
Discharged Patients ◽  
Record Review ◽  
Inpatient Units

Abstract Objectives This study utilized the method of medical record review to determine characteristics of adverse events that occurred in the inpatient units of hospitals in Korea as well as the variations in adverse events between institutions. Design A two-stage retrospective medical record review was conducted. The first stage was a nurse review, where two nurses reviewed medical records of discharged patients to determine if screening criteria had been met. In the second stage, two physicians independently reviewed medical records of patients identified in the first stage, to determine whether an adverse event had occurred. Setting Inpatient units of six hospitals. Participants Medical records of 2 596 patients randomly selected were reviewed in the first stage review. Intervention(s) N/A. Main Outcome Measure(s) Adverse events. Results A total of 277 patients (10.7%) were confirmed to have had one or more adverse event(s), and a total of 336 adverse events were identified. Physician reviewers agreed about whether an adverse event had occurred for 141 patients (5.4%). The incidence rate of adverse events was at least 1.3% and a maximum of 19.4% for each hospital. Most preventability scores were less than four points (non-preventable), and there were large variations between reviewers and institutions. Conclusions Given the level of variation in the identified adverse events, further studies that include more medical institutions in their investigations are needed, and a third-party committee should be involved to address the reliability issues regarding the occurrence and characteristics of the adverse events.

scholarly journals Diagnosis and treatment of patients with antiphospholipid syndrome: a mixed-method evaluation of care in The Netherlands

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Mirthe J Klein Haneveld ◽  
Caro H C Lemmen ◽  
Tammo E Brunekreef ◽  
Marc Bijl ◽  
A J Gerard Jansen ◽  
...  
Keyword(s):  
The Netherlands ◽  
Focus Groups ◽  
Medical Record ◽  
Medical Records ◽  
Quantitative Methods ◽  
Medical Record Review ◽  
Anticoagulant Treatment ◽  
Medical Specialists ◽  
Record Review ◽  
Fragmentation Of Care

Abstract Objectives The aims were to gain insight into the care provided to patients with APS in The Netherlands and to identify areas for improvement from the perspective of both patients and medical specialists. Methods APS care was evaluated using qualitative and quantitative methods. Perspectives on APS care were explored using semi-structured interviews with medical specialists, patient focus groups and a cross-sectional, online patient survey. In order to assess current practice, medical records were reviewed retrospectively to collect data on clinical and laboratory manifestations and pharmacological treatment in six Dutch hospitals. Results Fourteen medical specialists were interviewed, 14 patients participated in the focus groups and 79 patients completed the survey. Medical records of 237 patients were reviewed. Medical record review showed that only one-third of patients were diagnosed with APS within 3 months after entering specialist care. The diagnostic approach and management varied between centres and specialists. Almost 10% of all patients and 7% of triple-positive patients with thrombotic APS were not receiving any anticoagulant treatment at the time of medical record review. Correspondingly, poor recognition and fragmentation of care were reported as the main problems by medical specialists. Additionally, patients reported the lack of accessible, reliable patient education, psychosocial support and trust in physicians as important points for improvement. Conclusion Delayed diagnosis, variability in management strategies and fragmentation of care were important limitations of APS care identified in this study. A remarkable 10% of patients did not receive any anticoagulant treatment.

scholarly journals Design of a medical record review study on the incidence and preventability of adverse events requiring a higher level of care in Belgian hospitals

2012 ◽  
Vol 5 (1) ◽  
Author(s):  
Annemie Vlayen ◽  
Kristel Marquet ◽  
Ward Schrooten ◽  
Arthur Vleugels ◽  
Johan Hellings ◽  
...  
Keyword(s):  
Adverse Events ◽  
Medical Record ◽  
Medical Record Review ◽  
Level Of Care ◽  
Review Study ◽  
Record Review

scholarly journals Validity and reliability of a medical record review method identifying transitional patient safety incidents in merged primary and secondary care patients’ records

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e018576 ◽  
Author(s):  
Marije A van Melle ◽  
Dorien L M Zwart ◽  
Judith M Poldervaart ◽  
Otto Jan Verkerk ◽  
Maaike Langelaan ◽  
...  
Keyword(s):  
Patient Safety ◽  
Medical Record ◽  
Medical Records ◽  
Secondary Care ◽  
Information Transfer ◽  
Safety Issue ◽  
Medical Center ◽  
Medical Record Review ◽  
Measurement Tool ◽  
Record Review

ObjectiveInadequate information transfer during transitions in healthcare is a major patient safety issue. Aim of this study was to pilot a review of medical records to identify transitional safety incidents (TSIs) for use in a large intervention study and assess its reliability and validity.DesignA retrospective medical record review study.Settings and participantsCombined primary and secondary care medical records of 301 patients who had visited their general practitioner and the University Medical Center Utrecht, the Netherlands, in 2013 were randomly selected. Six trained reviewers assessed these medical records for presence of TSIs.OutcomesTo assess inter-rater reliability, 10% of medical records were independently reviewed twice. To assess validity, the identified TSIs were compared with a reference standard of three objectively identifiable TSIs.ResultsThe reviewers identified TSIs in 52 (17.3%) of all transitional medical records. Variation between reviewers was high (range: 3–28 per 50 medical records). Positive agreement for finding a TSI between reviewers was 0%, negative agreement 80% and the Cohen’s kappa −0.15. The reviewers identified 43 (22%) of 194 objectively identifiable TSIs.ConclusionThe reliability of our measurement tool for identifying TSIs in transitional medical record performed by clinicians was low. Although the TSIs that were identified by clinicians were valid, they missed 80% of them. Restructuring the record review procedure is necessary.

Abstract 109: Patients with Diabetes Have Decreased Survivability with Good Neurological Outcomes After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Beatrice Dayea Jang ◽  
Sang Do Shin ◽  
William McClellan ◽  
Bryan McNally
Keyword(s):  
Heart Disease ◽  
Medical Record ◽  
Cerebral Performance Category ◽  
Medical Record Review ◽  
Multivariate Logistic Regression Model ◽  
P Value ◽  
Neurological Outcomes ◽  
Brain Recovery ◽  
History Of ◽  
Record Review

Objectives: This study aims to provide a scientific evidence of the association between diabetes and the probability of OHCA survival with good neurological outcomes. Methods: Korean registry on patients survived to admission after emergency medical services (EMS)-assessed OHCA with cardiac etiology with known diabetes statuses (2009 to 2012) was used. We excluded patients without available hospital outcomes or diabetes. Diabetes was defined when the patients had history of treatment or diagnosis or positive result at laboratory test during hospital stay. Outcomes were survival to discharge with good brain recovery measured by medical record review by medical record review experts using cerebral performance category 1 or 2. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a multivariate logistic regression model adjusting for individual, Utstein, post-resuscitation factors, and comorbidities. Interaction model between diabetes and gender and heart disease were also analyzed. Results: Total 7463 patients including diabetes 1,952 (26.2%), non-diabetes 4,129 (55.3%), and unknown diabetes 1,382 (18.5%) were finally analyzed. Survival to discharge with good brain recovery was 17.7% in non-diabetes, 9.7% in diabetes 16.2% in unknown-diabetes, respectively (p<0.001). Crude OR (95% CI) was 0.50 (0.42-0.59) in diabetes and 0.89 (0.76-1.05) in unknown-diabetes comparing with non-diabetes. Adjusted OR (95% CI) was 0.78 (0.61-0.98) in diabetes and 1.07 (0.75-1.53) in unknown-diabetes comparing with non-diabetes. The adjusted OR measuring the effect of diabetes on survival with good neurological outcomes for male with history of heart disease was 0.32 (0.22-0.48, p-value <0.0001), for male without history of heart disease was 0.55 (0.34-0.89, p-value <0.0001), for female with history of heart disease was 0.60 (0.48-0.76, p-value 0.0152), and for female without history of heart disease was 1.03 (0.71-1.47, p-value 0.8919). Conclusion: This study provides evidence of significant associations of diabetes and decreased OHCA survivability with good neurological outcomes where the association is greater in male and patients with heart disease.

scholarly journals CareTrack Kids--part 3. Adverse events in children's healthcare in Australia: study protocol for a retrospective medical record review

BMJ Open ◽  
2015 ◽  
Vol 5 (4) ◽  
pp. e007750-e007750 ◽  
Author(s):  
P. D. Hibbert ◽  
A. R. Hallahan ◽  
S. E. Muething ◽  
P. Lachman ◽  
T. D. Hooper ◽  
...  
Keyword(s):  
Adverse Events ◽  
Medical Record ◽  
Study Protocol ◽  
Medical Record Review ◽  
Record Review ◽  
Retrospective Medical Record Review

scholarly journals ReCAP: Detection of Potentially Avoidable Harm in Oncology From Patient Medical Records

2016 ◽  
Vol 12 (2) ◽  
pp. 178-179 ◽  
Author(s):  
Allison Lipitz-Snyderman ◽  
Saul N. Weingart ◽  
Christopher Anderson ◽  
Andrew S. Epstein ◽  
Aileen Killen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Medical Record ◽  
Cancer Care ◽  
Medical Records ◽  
Screening Tool ◽  
Real Life ◽  
Risk Groups ◽  
Medical Record Review ◽  
Efficient Detection ◽  
Record Review

QUESTION ASKED: Although medical record–based measurement of adverse events (AEs) associated with cancer care is desirable, condition-specific triggers in oncology care are needed. We sought to develop a screening tool to facilitate efficient detection of AEs across settings of cancer care via medical record review. We hope to use this tool to understand the frequency, spectrum, and preventability of AEs with the goal of helping improve the quality and safety of cancer care. SUMMARY ANSWER: We developed a cancer-specific screening tool to help identify candidate preventable AEs that occur during cancer care from patients’ medical records. Our oncology screening tool consists of 76 triggers—readily identifiable findings to screen for possible AEs that occur during cancer care ( Table 1 ). METHODS: We sought to develop a screening tool to facilitate the detection of AEs across settings of cancer care via medical record review. We obtained structured and unstructured input from clinical experts to develop our tool, using a modified Delphi process. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Our oncology tool requires further evaluation in order to understand its usefulness for population-based assessments of AEs in oncology and quality improvement. REAL-LIFE IMPLICATIONS: Information obtained from structured record reviews using an oncology trigger tool could help to prioritize quality improvement activities, identify high-risk groups, and generate cancer-focused quality measures. Ultimately, the goals of this work are to prevent AEs and allow timely, automated identification of these events so that clinicians can intervene promptly to improve patient outcomes. [Table: see text]

Abstract P270: Automating Processes to Expedite Medical Record Review in Research

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
K M Reeder ◽  
Edward Ellerbeck ◽  
Marilyn Werkowitch ◽  
N. Nazir ◽  
B. Waltrip ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Room ◽  
Medical Record ◽  
Medical Records ◽  
Chart Review ◽  
Medical Record Review ◽  
Automated System ◽  
Emergency Room Visits ◽  
Automated Method ◽  
Record Review

Problem. Heart failure (HF) clinical trials often use medical record review data to determine HF related hospital events, such as emergency room visits and readmissions. However, reviewing medical records for each hospital event can be daunting. The purpose of this project was to expedite medical record review processes using an automated method for identifying potential HF related hospital events. Methods. A stepwise procedure was developed for obtaining electronic information of all consented HF clinical trial participants' hospital events. First, an electronic list of all study participants was generated from a study data base and electronically sent to the Medical Records department each month. Next, a list of all emergency room visits and hospitalizations, including admission and discharge dates, discharge disposition, and diagnosis and procedure codes was electronically generated by the Medical Records department. A trained cardiovascular research nurse reviewed the abstracted coding and billing data for each hospital event and identified specific codes potentially related to HF. Last, hospital events identified as meeting specific criteria were included in the medical record review. Results. Using the automated system, a total of 294 hospital events for 125 subjects were obtained from the Medical Records department during the initial 2 years of the clinical trial. Of these, 85 (29%) hospital events were identified as needing to undergo chart review. Thirty-three (39%) of the 85 charts that underwent blinded review were identified as being HF related hospital events. Conclusions. Automating procedures for obtaining hospital event information expedited both the systematic data review and chart review processes. In this study, combined use of automated processes for obtaining hospital event data and nurse review reduced the number of charts requiring blinded review by nearly 60%.

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