Alan J Forster1,2,3, Burnand Bernard4, Saskia E Drösler5, Yana Gurevich6, James Harrison7, Jean-Marie Januel8, Patrick S Romano9, Danielle A Southern10, Vijaya Sundararajan11,12, Hude Quan10, Saskia E Vanderloo2, Harold A Pincus13,14,15, William A Ghali10. 1. The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, ASB-1 Room 1-008, Ottawa, ON, Canada K1Y 4E9. 2. Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Box 511, Ottawa, ON, Canada K1H 8L6. 3. University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, Canada K1N 6N5. 4. Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland. 5. Faculty of Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, Krefeld 47805, Germany. 6. Canadian Institute of Health Information, 4110 Yonge Street, Suite 300, Toronto, Ontario, Canada M2P 2B7. 7. Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. 8. Quality & Safety, Host team in Healthcare Organization Management, Institute of Management, EHESP - School of Public Heath, Maison des Sciences de l'Homme (MSH) - Paris Nord 20 avenue Georges Sand, Paris, France 93210. 9. Division of General Medicine, University of California-Davis School of Medicine, 4150 V Street; Suite 2400, Sacramento, CA 95817, USA. 10. Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6. 11. Department of Medicine, St. Vincent's Hospital, Level 4, Daly Wing, University of Melbourne, Fitzroy VIC 3065, Australia. 12. Department of Medicine, Southern Clinical School, Monash University, Victoria 3800, Australia. 13. Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA. 14. Irving Institute for Clinical and Translational Research at Columbia University and New York-Presbyterian Hospital, 622 West 168 Street, Floor 10, Suite 305, New York, NY 10032, USA. 15. RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA.
Abstract
OBJECTIVE: To assess the utility of the proposed World Health Organization (WHO)'s International Classification of Disease (ICD) framework for classifying patient safety events. SETTING: Independent classification of 45 clinical vignettes using a web-based platform. STUDY PARTICIPANTS: The WHO's multi-disciplinary Quality and Safety Topic Advisory Group. MAIN OUTCOME MEASURE(S): The framework consists of three concepts: harm, cause and mode. We defined a concept as 'classifiable' if more than half of the raters could assign an ICD-11 code for the case. We evaluated reasons why cases were nonclassifiable using a qualitative approach. RESULTS: Harm was classifiable in 31 of 45 cases (69%). Of these, only 20 could be classified according to cause and mode. Classifiable cases were those in which a clear cause and effect relationship existed (e.g. medication administration error). Nonclassifiable cases were those without clear causal attribution (e.g. pressure ulcer). Of the 14 cases in which harm was not evident (31%), only 5 could be classified according to cause and mode and represented potential adverse events. Overall, nine cases (20%) were nonclassifiable using the three-part patient safety framework and contained significant ambiguity in the relationship between healthcare outcome and putative cause. CONCLUSIONS: The proposed framework enabled classification of the majority of patient safety events. Cases in which potentially harmful events did not cause harm were not classifiable; additional code categories within the ICD-11 are one proposal to address this concern. Cases with ambiguity in cause and effect relationship between healthcare processes and outcomes remain difficult to classify.
OBJECTIVE: To assess the utility of the proposed World Health Organization (WHO)'s International Classification of Disease (ICD) framework for classifying patient safety events. SETTING: Independent classification of 45 clinical vignettes using a web-based platform. STUDY PARTICIPANTS: The WHO's multi-disciplinary Quality and Safety Topic Advisory Group. MAIN OUTCOME MEASURE(S): The framework consists of three concepts: harm, cause and mode. We defined a concept as 'classifiable' if more than half of the raters could assign an ICD-11 code for the case. We evaluated reasons why cases were nonclassifiable using a qualitative approach. RESULTS: Harm was classifiable in 31 of 45 cases (69%). Of these, only 20 could be classified according to cause and mode. Classifiable cases were those in which a clear cause and effect relationship existed (e.g. medication administration error). Nonclassifiable cases were those without clear causal attribution (e.g. pressure ulcer). Of the 14 cases in which harm was not evident (31%), only 5 could be classified according to cause and mode and represented potential adverse events. Overall, nine cases (20%) were nonclassifiable using the three-part patient safety framework and contained significant ambiguity in the relationship between healthcare outcome and putative cause. CONCLUSIONS: The proposed framework enabled classification of the majority of patient safety events. Cases in which potentially harmful events did not cause harm were not classifiable; additional code categories within the ICD-11 are one proposal to address this concern. Cases with ambiguity in cause and effect relationship between healthcare processes and outcomes remain difficult to classify.
Authors: Danielle A Southern; James E Harrison; Patrick S Romano; Marie-Annick Le Pogam; Harold A Pincus; William A Ghali Journal: BMC Med Inform Decis Mak Date: 2022-02-24 Impact factor: 2.796
Authors: Lauren A Beaupre; Eugene K Wai; Donald R Hoover; Helaine Noveck; Darren M Roffey; Donald R Cook; Jay S Magaziner; Jeffrey L Carson Journal: Int J Qual Health Care Date: 2018-03-01 Impact factor: 2.038