(Thesis: M.S.P.H.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / INTRODUCTION: Although serious complications of invasive bedside procedures are rare they can be life threatening. Interest in identifying and preventing complications of bedside procedures has been heightened recently in light of such complications increasingly being linked to hospital reimbursement. In part I of this thesis we present the validation of ICD-9-CM codes for identification of the two most common complications associated with central venous catheterization. In part II we determine the impact of the development of a medical procedure service (MPS) on patient safety surrounding bedside procedures and resident education.
METHODS: Part I: Cases of iatrogenic pneumothorax and central line associated blood stream infections (CLABSI) identified by ICD-9-CM codes in discharge data provided by Boston University Medical Center to the University HealthSystem Consortium were compared with those revealed by medical record abstraction of central venous catheters placed between 7/10-12/11.
Part II: Retrospective cohort analysis of consecutive adults admitted to the internal medicine service who underwent a bedside medical procedure between 7/10-12/11 comparing characteristics and outcomes of procedures performed by the MPS versus primary services.
RESULTS: Part I: The ICD-9-CM code for iatrogenic pneumothorax (512.1) had a sensitivity of 66.7%, specificity of 100%, positive predictive value of 100% and negative predictive value of 99.5%. The ICD-9-CM codes for CLABSI (999.31 and 999.32) had a sensitivity of 41.7%, specificity of 98.0%, positive predictive value of 20.0% and negative predictive value of 99.3%.
Part II: We evaluated 1707 bedside procedures (548 by MPS, 1159 by primary services). While the MPS was more likely to successfully complete procedures (95.8% vs. 92.8%, p=0.02) and to use best practice safety process measures (95.4% vs. 51.0%, p<0.0001), the composite rate of major complications was similar (1.6% vs. 1.9%, p=0.71).
CONCLUSIONS: Complications associated with invasive beside procedures are rare. The low sensitivity and variable positive predictive value of ICD-9-CM codes for detection of complications of central venous catheterization limits their use for internal quality improvement purposes. While use of a medical procedure service was associated with increased use of evidence based process measures, it did not significant affect the rate of major complications associated with bedside procedures. / 2031-01-01
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/21266 |
| Date | January 2013 |
| Creators | Tukey, Melissa Hoffman |
| Publisher | Boston University |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
Page generated in 0.0022 seconds