Comparing Patient-Reported Hospital Adverse Events with Medical Record Review: Do Patients Know Something That Hospitals Do Not?

15 July 2008 | Volume 149 Issue 2 | Pages 100-108

Background: Hospitals routinely survey patients about the quality of care they receive, but little is known about whether patient interviews can detect adverse events that medical record reviews do not.

Objective: To compare adverse events reported in postdischarge patient interviews with adverse events detected by medical record review.

Design: Random sample survey.

Setting: Massachusetts, 2003.

Patients: Recently hospitalized adults.

Measurements: By using parallel methods, physicians reviewed postdischarge interviews and medical records to classify hospital adverse events.

Results: Among 998 study patients, 23% had at least 1 adverse event detected by an interview and 11% had at least 1 adverse event identified by record review. The statistic showed relatively poor agreement between interviews and medical records for occurrence of any type of adverse event ( = 0.20 [95% CI, 0.03 to 0.27]) and somewhat better agreement between interviews and medical records for life-threatening or serious events ( = 0.33 [CI, 0.20 to 0.45]). Record review identified 11 serious, preventable events (1.1% of patients). Interviews identified an additional 21 serious and preventable events that were not documented in the medical record, including 12 predischarge events and 9 postdischarge events, in which symptoms occurred after the patient left the hospital.

Limitations: Patients had to be healthy enough to be interviewed. Delay in reaching patients (6 to 12 months after discharge) may have resulted in poor recall of events during the hospital stay.

Conclusion: Patients report many events that are not documented in the medical record; some are serious and preventable. Hospitals should consider monitoring patient safety by adding questions about adverse events to postdischarge interviews.

Editors' Notes Context Some hospitals review a patient's hospital record to ascertain adverse events during a recent hospital stay. The accuracy of this procedure is unknown. Asking patients about adverse events is another approach. Contribution The authors surveyed randomly chosen patients discharged from all hospitals in Massachusetts. Of 998 patients who returned the surveys and gave permission for medical record review, 21 reported severe, potentially preventable adverse events in addition to the 11 such events recorded in the medical record. Caution The surveys took place 6 to 12 months after discharge. Implication Postdischarge patient surveys and medical record review are complementary ways to detect adverse events in the hospital. —The Editors

 

Author and Article Information

From Institute for Health Policy, Massachusetts General Hospital, Harvard School of Public Health, Dana-Farber Cancer Institute, and Massachusetts Department of Public Health, Boston, Massachusetts; Massachusetts Hospital Association, Burlington, Massachusetts; and Brown University, Providence, Rhode Island.

Acknowledgment: The authors thank Jack Fowler, PhD; Brian Clarridge, PhD; and Dragana Bolcic-Jankovic, MA, for help and support with questionnaire design and administration, and Nancy Wong for assistance with data analysis and programming.

Grant Support: By a cooperative agreement from the Agency for Healthcare Research and Quality to the Massachusetts Department of Public Health (U18 HS11928).

Potential Financial Conflicts of Interest: Grants received: J.S. Weissman (Agency for Healthcare Research and Quality), E.C. Schneider (Agency for Healthcare Research and Quality), S.N. Weingart (Agency for Healthcare Research and Quality), A.M. Epstein (Agency for Healthcare Research and Quality), J. David-Kasdan (Agency for Healthcare Research and Quality), S. Feibelmann (Agency for Healthcare Research and Quality), C.L. Annas (Agency for Healthcare Research and Quality), N. Ridley (Agency for Healthcare Research and Quality), L. Kirle (Agency for Healthcare Research and Quality).

Reproducible Research Statement: Study protocol and data set: Available from Dr. Weissman (e-mail, joel.weissman{at}state.ma.us). Statistical code: Not available.

Requests for Single Reprints: Joel S. Weissman, PhD, Massachusetts Executive Office of Health and Human Services, One Asburton Place, Room 1109, Boston, MA 02108; e-mail, joel.weissman{at}state.ma.us.

Current Author Addresses: Dr. Weissman: Massachusetts Executive Office of Health and Human Services, One Ashburton Place, Room 1109, Boston, MA 02108.

Drs. Schneider and Epstein: Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.

Dr. Weingart: Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.

Ms. David-Kasdan and Ms. Feibelmann: Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.

Ms. Annas: Eastern Massachusetts Healthcare Initiative, 14 Story Street, 2nd Floor, Cambridge, MA 02138.

Ms. Ridley: Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108.

Ms. Kirle: Tufts Medical Center, 800 Washington Street, Boston, MA 02111.

Dr. Gatsonis: Brown University, Center for Statistical Sciences, Box GS-121, Providence, RI 02912.

Author Contributions: Conception and design: J.S. Weissman, E.C. Schneider, S.N. Weingart, A.M. Epstein, C.L. Annas, N. Ridley, L. Kirle, C. Gatsonis.

Analysis and interpretation of the data: J.S. Weissman, E.C. Schneider, S.N. Weingart, A.M. Epstein, J. David-Kasdan, L. Kirle.

Drafting of the article: J.S. Weissman, J. David-Kasdan, S. Feibelmann, N. Ridley, L. Kirle.

Critical revision of the article for important intellectual content: J.S. Weissman, E.C. Schneider, S.N. Weingart, A.M. Epstein, J. David-Kasdan, S. Feibelmann, C.L. Annas, N. Ridley.

Final approval of the article: J.S. Weissman, E.C. Schneider, S.N. Weingart, A.M. Epstein, J. David-Kasdan, S. Feibelmann.

Statistical expertise: C. Gatsonis.

Obtaining of funding: J.S. Weissman, A.M. Epstein, N. Ridley, L. Kirle, C. Gatsonis.

Administrative, technical, or logistic support: J.S. Weissman, S.N. Weingart, J. David-Kasdan, S. Feibelmann.

Collection and assembly of data: J.S. Weissman, J. David-Kasdan.

Read all Rapid Responses

Eight Years After IOM Report: Patient Reports more Reliable than Hospitals

Daniel R Longo

Annals Online, 15 Jul 2008 [Full text]

Comparing Patient-Reported Hospital Adverse Events with Medical Record Review

Madeleine C. Blaurock

Annals Online, 21 Jul 2008 [Full text]