skip to page content
Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Go to the ORD website
Go to the QUERI website

HSR&D Citation Abstract

Search | Search by Center | Search by Source | Keywords in Title

Development and testing of tools to detect ambulatory surgical adverse events.

Mull HJ, Borzecki AM, Hickson K, Itani KM, Rosen AK. Development and testing of tools to detect ambulatory surgical adverse events. Journal of Patient Safety. 2013 Jun 1; 9(2):96-102.

Related HSR&D Project(s)

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
   Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions


OBJECTIVES: Numerous health-care systems in the United States, including the Veterans Health Administration (VA), use the National Surgical Quality Improvement Program (NSQIP) to detect surgical adverse events (AEs). VASQIP sampling methodology excludes many routine ambulatory surgeries from review. Triggers, algorithms derived from clinical logic to flag cases where AEs have most likely occurred, could complement VASQIP by detecting a higher yield of ambulatory surgeries with a true surgical AE. METHODS: We developed and tested a set of ambulatory surgical AE trigger algorithms using a sample of fiscal year 2008 ambulatory surgeries from the VA Boston Healthcare System. We used VA Boston VASQIP-assessed cases to refine triggers and VASQIP-excluded cases to test how many trigger-flagged surgeries had a nurse chart review-detected surgical AE. Chart review was performed using the VA electronic medical record. We calculated the ratio of cases with a true surgical AE over flagged cases (i.e., the positive predictive value [PPV]), and the 95% confidence interval for each trigger. RESULTS: Compared with the VASQIP rate (9 AEs, or 2.8%, of the 322 charts assessed), nurse chart review of the 198 trigger-flagged surgeries yielded more cases with at least 1 AE (47 surgeries with an AE, or 6.0%, of the 782 VASQIP-excluded ambulatory surgeries). Individual trigger PPVs ranged from 12.4% to 58.3%. CONCLUSIONS: In comparison with VASQIP, our set of triggers identified a higher rate of surgeries with AEs in fewer chart-reviewed cases. Because our results are based on a relatively small sample, further research is necessary to confirm these findings.

Questions about the HSR&D website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.