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Informatics and the American College of Surgeons National Surgical Quality Improvement Program: automated processes could replace manual record review.

TitleInformatics and the American College of Surgeons National Surgical Quality Improvement Program: automated processes could replace manual record review.
Publication TypeJournal Article
Year of Publication2009
AuthorsHanauer, DA, Englesbe, MJ, Cowan, JA, Campbell, DA
JournalJ Am Coll Surg
Volume208
Issue1
Pagination37-41
Date Published2009 Jan
ISSN1879-1190
KeywordsAutomatic Data Processing, Data Collection, Feasibility Studies, Forms and Records Control, General Surgery, Humans, Medical Audit, Medical Informatics, Medical Records, Medical Records Systems, Computerized, Myocardial Infarction, Outcome Assessment (Health Care), Postoperative Complications, Pulmonary Embolism, Quality Assurance, Health Care, Quality of Health Care, United States
Abstract

BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) provides reliable, risk-adjusted outcomes data using standardized definitions and end points. Collection of the data is time consuming, and the surgical clinical nurse reviewers (SCNRs) can sample only a subset of all surgical cases. We sought to test the feasibility of using an informatics tool to automatically identify postoperative complications stored as free-text documents in our electronic medical record.STUDY DESIGN: We used a locally developed electronic medical record search engine (EMERSE) to build sets of terminology that could accurately identify postoperative complications of both myocardial infarction (MI) and pulmonary embolism (PE) as defined by the ACS-NSQIP. All complications had been previously identified by our SCNRs and these were considered the gold standard. We used 5,894 cases from 2001 to 2004 from our institution's ACS-NSQIP dataset for building the terminology and 4,898 cases from 2005 to 2006 for validation. False-positive cases were then further reviewed manually.RESULTS: We achieved sensitivities of 100.0% and 92.8% for identifying postoperative myocardial infarction and pulmonary embolism, respectively, with somewhat lower specificities of 93.0% and 95.9%, respectively. These results compared favorably with results from the SCNRs, especially because our manual review uncovered cases previously missed.CONCLUSIONS: Informatics has the potential to improve the efficiency and accuracy of chart abstraction by SCNRs for the ACS-NSQIP. Using such tools may eventually allow all cases at an institution to be reviewed rather than a small subset.

DOI10.1016/j.jamcollsurg.2008.08.030
Alternate JournalJ. Am. Coll. Surg.
PubMed ID19228500
People: 
David Hanauer
University of Michigan Rogel Cancer Center at North Campus Research Complex
1600 Huron Parkway, Bldg 100, Rm 1004 
Mailing Address: 2800 Plymouth Rd, NCRC 100-1004
Ann Arbor, MI 48109-2800 

Research reported in this publication was supported by the National Cancer Institutes of
Health under Award Number P30CA046592. The content is solely the responsibility
of the authors and does not necessarily represent the official views of the
National Institutes of Health.

Research reported in this publication was supported by the National Cancer Institutes of
Health under Award Number P30CA046592 by the use of the following Cancer Center
Shared Resource(s): Biostatistics, Analytics & Bioinformatics; Flow Cytometry;
Transgenic Animal Models; Tissue and Molecular Pathology; Structure & Drug
Screening; Cell & Tissue Imaging; Experimental Irradiation; Preclinical
Imaging & Computational Analysis; Health Communications; Immune Monitoring;
Pharmacokinetics)

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