Detection of Adverse Events With the Austrian Inpatient Quality Indicators.

OBJECTIVES: Indicators based on routine data are considered a readily available and cost-effective method for assessing health care quality and safety. The Austrian Inpatient Quality Indicators (A-IQI) have been introduced in all Austrian public hospitals as a mandatory quality measurement. The purpose of this study was to assess the value of conspicuous A-IQI in predicting the presence of adverse events (AEs). METHODS: We conducted an exploratory study comparing all indicator-positive patient cases contributing to 18 conspicuous A-IQI indicators to randomly selected indicator-negative control cases regarding the prevalence and severity of AEs. Structured medical record review using the Institute for Healthcare Improvement Global Trigger Tool was used as the gold standard. RESULTS: In 421 chart reviews, we identified 158 AEs. 70.9% (n = 112) of the AEs were found in cases with a positive indicator. The relative risk of an AE occurring was 3.47 (95% confidence interval: 2.30, 5.24) in indicator-positive cases compared to indicator-negatives. The proportion of severe events (National Coordination Council for Medication Error Reporting and Prevention Index categories H and I) was 54.5% (n = 61) in indicator-positive cases and only 15.3% (n = 7) in indicator-negative cases. Overall sensitivity of the A-IQI was 68.2%, specificity 69.4%, positive predictive value 36.0%, and negative predictive value 89.6%. CONCLUSIONS: Our study shows that significantly more AEs and more severe AEs were found in cases with positive A-IQI than in indicator-negative control cases. However, studies with larger numbers of cases and with larger numbers of conspicuous indicators are needed for the validation of the entire A-IQI indicator set.

Circadian melatonin profiles during single 24-h shifts in anesthetists.

PURPOSE: It has been shown that shift work constitutes a great health hazard, particularly when chronodisruption is involved. Anesthetists are used to working for a certain number of 24-h shifts every month. The work-related lack of sleep in combination with light exposure is suspected to alter melatonin courses. The main aim of the present study was to analyze circadian melatonin profiles before, during, and after a 24-h shift in anesthetists and medical students (controls). Furthermore, we evaluated possible differences in melatonin profiles between the groups. Interactions between specific parameters were calculated. METHODS: Over three consecutive days, including a 24-h shift, urine samples were collected daily at five time points. 6-Sulfateoxymelatonin (aMT6-s) courses were assayed using a commercially available competitive immunoassay kit. RESULTS: Ten anesthetists aged between 29 and 35 years and ten medical students aged between 25 and 31 years were included in the study. aMT6-s fluctuated between nocturnal values of (mean [range]) 2.2 (1.4; 3.0) pg/ml and morning values of 25.5 (12.1; 39.0) pg/ml. A marked circadian rhythm of aMT6-s courses was observed in both groups. Analyses of variance showed an effect of the factor "time" on aMT6-s concentrations but not of the factor "anesthetists versus students". Correlations between aMT6-s, the amount of sleep, and the time since the last extended duration shift could be found. CONCLUSIONS: The results show no evidence for a single 24-h shift having a great impact on circadian disruption as evidenced by a similar melatonin profile for both groups over the study phase.