Safety and Quality of Care

AHRQ patient safety indicator can be used to identify cases of hospital-acquired collapsed lung

Pneumothorax (collapsed lung) is a relatively frequent and potentially serious complication of hospital procedures performed near the lung. The complication is most commonly associated with central vein catheter (CVC) placement, nasogastric tube insertion, and other procedures involving the neck or chest wall that introduce air into the space between the pleural membrane and the lung. Symptoms include sudden chest pains, shortness of breath, and rapid heart beat. A new study shows that the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI) 6, Iatrogenic (hospital-acquired) Pneumothorax, can identify this complication from administrative data. It also suggests that many of these complications could have been prevented with use of real-time ultrasound guidance when performing CVC insertion and other procedures.

AHRQ has developed PSIs of potentially preventable complications using readily available administrative data. The indicators are based on diagnostic codes and have become a widely used tool to assess, monitor, and compare safety-related aspects of hospital performance. The study found that PSI 6 software, used to analyze hospital administrative data for 200 randomly selected cases of suspected pneumothorax from 28 hospitals, correctly identified 78 percent of cases that were confirmed on the basis of chart-abstracted data. CVC placement was found to be associated with 44 percent of the pneumothorax events (59 events). However, only five of these procedures used ultrasound guidance, which is known to reduce the risk of pneumothorax by more than half.

The findings were based on a retrospective study of a cross-section of records that met criteria for PSI 6 from a voluntary group of 47 hospitals in 29 States. However, only 28 of the hospitals had pneumothorax cases involving a hospital discharge between October 2005 and March 2007. The study was funded in part by the Agency for Healthcare Research and Quality (Contract No. 290-04-0020).

More details are in "Cases of iatrogenic pneumothorax can be identified from ICD-9-CM coded data," by Banafsheh Sadeghi, M.D., Ph.D., Ruth Baron, R.N., Patricia Zrelak, Ph.D., and others in the March 2010 American Journal of Medical Quality 25(3), pp. 218-224.

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