PMID- 36414501
OWN - NLM
STAT- MEDLINE
DCOM- 20230207
LR  - 20230207
IS  - 1879-0267 (Electronic)
IS  - 0020-1383 (Linking)
VI  - 54
IP  - 2
DP  - 2023 Feb
TI  - Recording adverse events following orthopaedic trauma: Financial implications and 
      validation of an adverse event assessment form in an Irish regional trauma unit.
PG  - 508-512
LID - S0020-1383(22)00848-8 [pii]
LID - 10.1016/j.injury.2022.11.012 [doi]
AB  - BACKGROUND: In Ireland, funding of orthopaedic trauma is based on an 
      activity-based funding (ABF) model. Clinically similar cases are split into 
      diagnostic-related groups (DRG), with base funding per DRG provided. Increased 
      complexity of cases (length of stay; complications incurred; occurrence of 
      adverse events) attracts additional remuneration to the base funding. In our 
      institution these adverse events are recorded via retrospective chart-abstraction 
      methods by administrative staff. Incidences which are not included from this 
      review affect both follow up with family physicians and patient care; as well as 
      skewing budgetary decisions that impact fiscal viability of the service. The aim 
      of this study was to compare a prospectively implemented adverse events form with 
      the current national retrospective chart abstraction method. Our outcomes in 
      terms of pay-by-results financial implications. METHODS: An adverse events 
      database adapted from a similar validated model was used to prospectively record 
      complications in 216 patients admitted via the orthopaedic trauma service. Data 
      was contemporaneously collected via a GDPR compliant secure medical messaging 
      platform. Results were compared with the same cohort using an existing data 
      abstraction method. Both data sets were coded in accordance with current 
      standards for case funding. RESULTS: Overall, 49 adverse events were recorded 
      during the study through prospective charting of adverse events, compared with 26 
      events documented by customary method (p<0.01).Anaemia requiring blood 
      transfusion n = 11 22.4%) was the most common complication, followed by delirium 
      n = 6 (12%), acute kidney injury n = 6 (12%), and pneumonia n = 5 (10.2%). Missed 
      appropriate funding through conventional methods totalled euro40,293 . CONCLUSION: 
      This pilot study demonstrates the ability to improve capture of adverse events 
      through use of a well-designed assessment form. Proper perioperative data 
      handling is a critical aspect of financial subsidies, enabling optimal allocation 
      of funds.
CI  - Copyright (c) 2022. Published by Elsevier Ltd.
FAU - Timon, Charlie
AU  - Timon C
AD  - Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin 24, 
      Ireland. Electronic address: charleswilliamtimon@rcsi.com.
FAU - Lee, Matthew
AU  - Lee M
AD  - Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin 24, 
      Ireland.
FAU - Feeley, Iain
AU  - Feeley I
AD  - Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin 24, 
      Ireland.
FAU - Quinlan, John
AU  - Quinlan J
AD  - Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin 24, 
      Ireland.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20221109
PL  - Netherlands
TA  - Injury
JT  - Injury
JID - 0226040
SB  - IM
MH  - Humans
MH  - Retrospective Studies
MH  - Prospective Studies
MH  - *Trauma Centers
MH  - Pilot Projects
MH  - *Orthopedics
OTO - NOTNLM
OT  - Adverse
OT  - Cost
OT  - Economic
OT  - Orthopaedic
OT  - Trauma
EDAT- 2022/11/23 06:00
MHDA- 2023/02/08 06:00
CRDT- 2022/11/22 22:04
PHST- 2022/05/19 00:00 [received]
PHST- 2022/09/27 00:00 [revised]
PHST- 2022/11/07 00:00 [accepted]
PHST- 2022/11/23 06:00 [pubmed]
PHST- 2023/02/08 06:00 [medline]
PHST- 2022/11/22 22:04 [entrez]
AID - S0020-1383(22)00848-8 [pii]
AID - 10.1016/j.injury.2022.11.012 [doi]
PST - ppublish
SO  - Injury. 2023 Feb;54(2):508-512. doi: 10.1016/j.injury.2022.11.012. Epub 2022 Nov 
      9.