Monday, December 24, 2007

Recent study lauds automated surveillance; it may be superior to voluntary reporting

Recent study lauds automated surveillance; it may be superior to voluntary reporting

Key Points


* ADEs detected at a rate 3.6 times that of voluntary reporting at a university hospital and 12.3 times that at a community hospital.


* Goal of system is not just to detect ADEs, but to determine whether they are being reduced.


* Automated surveillance is much smaller number costly than computerized physicians order entry.


In a recent study conducted by researchers at Duke University, within Durham, NC, the use of an automated surveillance system for identifying adverse drug events (ADEs) proved far superior to voluntary reporting. (The study be published online ahead of print in the Journal of the American Information Association.) The system was implement at Duke University Hospital, an academic medical center, and at Raleigh Community Hospital. Potential events identified by the computer be reviewed by medication safety pharmacists and score for causality and severity; findings were compared between the two hospitals and near voluntary reports from nurses and pharmacists.


Over the eight-month study period, 25,177 patients be admitted to the university hospital and 8,029 to the community hospital. There be 1,116 ADEs in 900 patients at the university hospital for an overall rate of 4.4 ADEs per 100 admission.


At the community hospital, 399 patients experienced 501 ADEs for a rate of 6.2 events per 100 admissions. The computerized surveillance detected ADEs at a rate 3.6 times that of voluntary reporting at the university hospital and 12.3 times that at the community hospital.


"We believe it's earth-shattering to know the incidence of ADEs in order to numeral out how to reduce the number and to be capable of show we've made a difference," says Peter M. Kilbridge, MD, assistant professor of pediatrics at Duke Medical School, associate CIO for Duke University Health System, and organize author of the study.


Grant funds study


The research team received a $1.4 million give up from the Association for Healthcare Research and Quality (AHRQ) to fund the study. "AHRQ has spent greatly of time over the past few years looking at different technology for health diligence and ranking effectiveness, and at hand are a number they consider highly influential," Kilbridge notes. "This expert approach of using computers to detect adverse drug events in patients was in truth invented about 15 years ago and is immensely underutilized, yet it falls into AHRQ's schedule of "highly forceful use of information technology to improve sanctuary.'"


He reiterates that "if you don't know how many ADEs you own, you can't show you've made a difference." Most hospitals, says Kilbridge, use a voluntary system to report ADEs.


"The problem beside voluntary reporting is that it is totally anecdotal," he says. "It depends on the reporter recognize that an event happened and have both the time and the inclination to report it. It has undeniably no bearing on the actual number of ADEs."


While conceding that near often is a reluctance among staff to report such events, Kilbridge say that is not the biggest issue next to voluntary reporting. "The literature shows that most clinicians do not recognize an adverse drug event--or an adverse event at adjectives," he says. "Lots of times population are preoccupied by something else, or they figure something discouraging happened to the tolerant because of disease and do not see a cause-and-effect relationship with an ADE."


System developed in-house


So, armed beside the AHRQ grant, Kilbridge and his troop set out to create the surveillance system to "try to get a bar on the actual number of events." While there be a few pieces in place, he say he basically developed the system from gash, with the aid of "a large army of programmers."


In day-to-day, real-world language, the system looks at patient background in the hospital systems--lab notes, medications that the patients are on--and afterwards looks for indications in that data that the merciful may have have harm from a drug. "For example, they may enjoy been given an antidote to a drug, or have a very soaring level of a toxic drug, or a lab advantage changed that suggested a drug they were on be the cause," Kilbridge explains.


The system's computer is related to the hospitals' computer systems and flags these potential indicators. Then, the pharmacist goes and investigates respectively one to see if the "flag" represents a true adverse event.


As it determines the total number of ADEs, the system also provides baseline data, so that surrounded by the future researchers can see if progress have been made surrounded by reducing the number of events. "In one particular nouns [he was not free to identify] we hold already been competent to show such a difference," says Kilbridge.


Is it practical for frequent hospitals to have such a system, or would it be too costly minus a grant such as the one Duke received from AHRQ?


"My best answer is, compared near other kinds of technology systems relations are implementing, this is fundamentally inexpensive," Kilbridge asserts. "If you do CPOE [computerized physician order entry], for a 400-bed hospital it could cost you at most minuscule $7 million or $8 million. A system like this, if you do it from score, is in the proclaim of maybe $100,000 to $200,000, depending on how well-mannered your IT department is."


In fact, say Kilbridge, "AHRQ gives ADE surveillance systems a highly developed effectiveness rating than it give CPOE--and it is clearly a much smaller dollar investment."

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