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Using a Hybrid Electronic Medical Record System for the Surveillance of Adverse Surgical Events and Human Error in A Developing World Surgical Service

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Abstract

Introduction

The quantification and analysis of adverse events is essential to benchmark surgical outcomes and establish a foundation for quality improvement interventions. We developed a hybrid electronic medical record (HEMR) system for the accurate collection and integration of data into a structured morbidity and mortality (M&M) meeting.

Methodology

The HEMR system was implemented on January 1, 2013. It included a mechanism to capture and classify adverse events using the ICD-10 coding system. This was achieved by both prospective reporting by clients and by retrospective sentinel-event-trawling performed by administrators.

Results

From January 1, 2013 to March 20, 2014, 6,217 patients were admitted within the tertiary surgical service of Greys Hospital. A total of 1,314 (21.1 %) adverse events and 315 (5.1 %) deaths were recorded. The adverse events were divided into 875 “pathology-related” morbidities and 439 “error-related” morbidities. Pathology-related morbidities included 725 systemic complications and 150 operative complications. Error-related morbidities included 257 cognitive errors, 158 (2.5 %) iatrogenic injuries, and 24 (1.3 %) missed injuries. Error accounted for 439 (33 %) of the total number of adverse events. A total of 938 (71.4 %) adverse events were captured prospectively, whereas the remaining 376 (28.6 %) were captured retrospectively. The ICD-10 coding system was found to have some limitations in its classification of adverse events.

Conclusions

The HEMR system has provided the necessary platform within our service to benchmark the incidence of adverse events. The use of the international ICD-10 coding system has identified some limitations in its ability to classify and categorise adverse events in surgery.

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Author information

Authors and Affiliations

  1. Surgery, UKZN, Durban, South Africa

    Grant Laing

  2. General Surgery, Greys Hospital, Pietermaritzburg, South Africa

    John Bruce, Nikki Allorto & Damian Clarke

  3. Critical Care and Anaesthesia, King Edward VIII Hospital, Durban, South Africa

    David Skinner

  4. School of Clinical Medicine, King Edward VIII Hospital, Durban, South Africa

    Colleen Aldous

  5. Gastrointestinal Unit University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa

    Sandie Thomson

Authors
  1. Grant Laing
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  2. John Bruce
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  3. David Skinner
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  4. Nikki Allorto
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  5. Colleen Aldous
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  6. Sandie Thomson
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  7. Damian Clarke
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Corresponding author

Correspondence to Grant Laing.

Appendix

Appendix

See Appendix Figs. 4, 5, and 6.

Fig. 4
figure 4

HEMR system interface: ICD-10 search engine

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Fig. 5
figure 5

HEMR system interface: ICD-10 drop-down boxes and free-text description

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Fig. 6
figure 6

HEMR system automated digital report

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Laing, G., Bruce, J., Skinner, D. et al. Using a Hybrid Electronic Medical Record System for the Surveillance of Adverse Surgical Events and Human Error in A Developing World Surgical Service. World J Surg 39, 70–79 (2015). https://doi.org/10.1007/s00268-014-2766-x

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  • DOI: https://doi.org/10.1007/s00268-014-2766-x

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