107 Supporting A Culture of Quality: Integration of a Self-Reported Adverse Event Tracking System into an EPIC-Based Electronic Health Record at an Academic Institution. Issue Volume 61:Issue CN Supp. 1(2014)Supplement (1st August 2014)

• Record Type: Journal Article
• Authors: Penar, Paul L.
• Is Part Of: Neurosurgery. Volume 61:Issue CN Supp. 1(2014)Supplement
• Page Start: 193
• Page End: 194
• Publication Date: 2014-08-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/01.neu.0000452381.33329.6d
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Self-reporting of unexpected and adverse events for the purposes of performance improvement and education is important to surgeons, especially in an academic environment, promoting and supporting a culture of ownership and responsibility that comes naturally to surgeons. Since the 1990s, the Department of Surgery at the University of Vermont has been using a paper-based system to track all postoperative adverse events out to 30 days, using this data for M&M conferences, re-credentialing, and research. This system has been shown to capture a greater number of relevant complications, especially mortalities, than an administrative data set such as that of the University Health Consortium. Early studies showed that 50% of complications were judged by peers to be possibly avoidable, and an increased rate of complications after work hour restrictions (1-3). However, a paper-based system is now prohibitively labor-intensive. METHODS: We integrated the postoperative data collection system into an EPIC-based Electronic Health Record (EHR), with particular attention to the needs of an academic Neurosurgery Division. Legal protection from discovery is maintained. We also developed a unique classification system for Neurosurgical complications based on location (cranial, spinal, peripheral nerve), and etiology (infection, vascular/ischemic, hemorrhage/edema, neurologic deficit, cerebrospinal fluid-related, technical). RESULTS: The process of implementation across a wide range of surgical services is examined, electronic data entry forms demonstrated, and the possibilities for integration with external outcomes databases such as N2QOD are described. CONCLUSION: Documentation of postoperative events within an EHR is feasible, and supports the culture of ownership of quality improvement by surgeons.