Risk Factors and Outcomes for Foreign Body Left During a Procedure Analysis of 413 Incidents After 1 946 831 Operations in Children
ABSTRACT To determine risk factors and outcomes associated with a foreign body left during a procedure in a population of pediatric surgical patients.
The Nationwide Inpatient Sample and Kids' Inpatient Database were used to identify hospitalized pediatric surgical patients in the United States (aged 0-18 years) from 1988 to 2005.
After data from 1 946 831 hospitalizations in children were linked to the Agency for Healthcare Research and Quality Pediatric Quality Indicator (PDI) software, 413 pediatric patients with foreign bodies left during a procedure (PDI 3) were identified. A 1:3 matched case-control design was implemented with 413 cases and 1227 controls. Cases and controls were stratified into procedure categories based on diagnosis related group procedure codes.
To examine the relationship between PDI 3 and procedure category, as well as the outcomes of in-hospital mortality, length of stay, and total hospital charges.
Logistic regression analysis revealed a statistically significant higher odds of PDI 3 in the gynecology procedure category (odds ratio, 4.13; P = .01). Multivariable regression analysis revealed that patients with PDI 3 had an 8-day longer length of stay (95% confidence interval, 5.6-10.3 days; P < .001) and $35 681 higher total hospital charges (95% confidence interval, $22 358-$49 004; P < .001) but were not more likely to die (odds ratio, 1.07; P = .92).
Among pediatric surgical admissions, a foreign body left during a procedure was observed to occur with highest likelihood during gynecologic operations. The occurrence of this adverse event was associated with longer length of stay and greater total hospital charges, but not with increased mortality.
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ABSTRACT: To investigate whether a priori selection of patient records using unexpectedly long length of stay (UL-LOS) leads to detection of more records with adverse events (AEs) compared to non-UL-LOS. To investigate the opportunities of the UL-LOS, we looked for AEs in all records of patients with colorectal cancer. Within this group, we compared the number of AEs found in records of patients with a UL-LOS with the number found in records of patients who did not have a UL-LOS. Our study was done at a general hospital in The Netherlands. The hospital is medium sized with approximately 30 000 admissions on an annual basis. The hospital has two major locations in different cities where both primary and secondary care is provided. The patient records of 191 patients with colorectal cancer were reviewed. Number of triggers and adverse events were the primary outcome measures. In the records of patients with colorectal cancer who had a UL-LOS, 51% of the records contained one or more AEs compared with 9% in the reference group of non-UL-LOS patients. By reviewing only the UL-LOS group with at least one trigger, we found in 84% (43 out of 51) of these records at least one adverse event. A priori selection of patient records using the UL-LOS indicator appears to be a powerful selection method which could be an effective way for healthcare professionals to identify opportunities to improve patient safety in their day-to-day work.BMJ Open 07/2013; 3(7). DOI:10.1136/bmjopen-2013-003034 · 2.06 Impact Factor
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ABSTRACT: We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. A higher percentage of patients with an unexpectedly long length of stay (UL-LOS) compared to the national average may indicate shortcomings in patient safety. We explored the utility of the UL-LOS indicator.BMJ Open 06/2014; 4(6):e004773. DOI:10.1136/bmjopen-2013-004773 · 2.06 Impact Factor
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ABSTRACT: /st> To investigate the correlation between length of stay (LOS) and patient satisfaction on the level of hospital wards. The underlying hypothesis is that good quality of care leads both to shorter LOS and to patients that are more satisfied. /st> We used standardized LOS and standardized patient satisfaction data from seven specialisms: internal medicine, cardiology, pulmonology, neurology, general surgery, orthopaedic surgery and obstetrics and gynaecology in the period 2003-2010. All LOS data were derived from the National Medical Registration and patient satisfaction scores were measured by a questionnaire covering six aspects of care. The LOS data were standardized for the year of discharge, age, primary diagnosis and procedure. Patient satisfaction data were standardized for the year, age, education and health status. /st> One hundred and eighty-eight Dutch hospital wards. /st> The patient satisfaction data were gathered by questionnaires returned by 102 815 patients. /st> None. /st> Pearson correlations and two-tailed significance. between standardized mean LOS and standardized mean patient satisfaction score. /st> We found no correlation between LOS and patient satisfaction in six out of seven specialties. We only found significantly higher patient satisfaction scores in pulmonology for some specific items on hospitals wards with a shorter LOS. These items concerned the reception on the ward, the information provided by nurses on admission, the expertise of the nursing staff, the way information was transferred from one person to another and respect for patients' privacy such as in conversations, and during physical examinations. /st> We found no evidence that hospital wards with a relatively short mean LOS had higher, or lower, patient satisfaction than hospital wards with a relatively long LOS, with the exception of pulmonology.International Journal for Quality in Health Care 07/2012; 24(5):443-51. DOI:10.1093/intqhc/mzs037 · 1.58 Impact Factor