Adverse event rates as measures of hospital performance-A chance for organizational learning. In reply to ''Adverse event rates as measures of hospital performance'-Conflation and confusion with the use of the complications code'

摘要

Dev Kevat and Peter Cameron raise concerns about 'methodological shortcomings' of our recent paper that we are pleased to have an opportunity to address here. Their argument is that many complications arising while patients are hospitalised are 'inevitable' because they are caused by the underlying clinical condition of the patients. Therefore, they argue, hospital management has little control over the occurrence of complications, which makes them poor measures of hospital quality. We disagree for a number of reasons, and we further argue that consistent routine monitoring of in-hospital complications is one of the most important tools for improving patient safety and quality of care.First, our study was motivated by the need for better indicators of quality of care in assessments of hospital performance. Existing quality measures are inadequate in many ways. The most commonly used are mortality and readmission rates, but both are rare events. We have to ask what the quality of care experienced by the majority of patients has to do with them. Adverse events, on the other hand, are frighteningly common [1].