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Improving the identification of Postoperative Wound Dehiscence missed by the Patient Safety Indicator algorithm
Abstract Background The Patient Safety Indicator (PSI) Postoperative Wound Dehiscence (PWD) is an administrative data-based algorithm that flags cases using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 54.61 (abdominal wall disruption reclosure). We...
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Published in: | The American journal of surgery 2013-06, Vol.205 (6), p.674-680 |
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Main Authors: | , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | Abstract Background The Patient Safety Indicator (PSI) Postoperative Wound Dehiscence (PWD) is an administrative data-based algorithm that flags cases using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 54.61 (abdominal wall disruption reclosure). We examined how often PWD missed events and explored ways to improve event identification. Methods We selected 125 high-risk unflagged cases based on predicted probability and the presence of clinically relevant codes. We determined the false-negative proportion and associated reasons through chart review and calculated likelihood ratios of associated codes. Results Thirty-two percent of cases were false negatives, 60% of which lacked any abdominal wall repair codes. All individual codes had low likelihood ratios; the combination of diagnosis code 998.3x (operative wound disruption) and particular abdominal wall repair procedure codes occurred exclusively in false-negative cases (representing 24% of false-negative cases). Conclusions Among high-risk cases, the PWD algorithm frequently missed events. Coder training to clarify assignment of abdominal wall repair codes, plus adding specific code combinations to the algorithm, would improve event identification. |
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ISSN: | 0002-9610 1879-1883 |
DOI: | 10.1016/j.amjsurg.2012.07.040 |