Las Vegas Sun

April 23, 2014

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Do No Harm: Hospital Care in Las Vegas:

How the Sun identified surgical injuries

Every surgery results in an operative report, in which the surgeon notes each step of the procedure, including any inadvertent nicks, cuts or complications.

Hospital employees translate operative reports and other medical charts into billing codes that the facility uses to get paid.

The billing records — one for every patient — are filed with the state and have laid the foundation for the Las Vegas Sun’s investigation: “Do No Harm: Hospital Care in Las Vegas.”

For this installment, the Sun analyzed billing records from 1999 to 2009 to report on accidental punctures or lacerations in Las Vegas hospitals. In 2008 and 2009, the data allowed the Sun to identify specific injuries.

Each record, nearly 3 million in all, includes details such as age, gender, diagnoses and procedures performed in the hospital. The records do not include information that identifies the patients.

The newspaper used methods developed by the federal Agency for Healthcare Research and Quality to identify the injuries in the billing codes and compare them with expected national norms. The agency collects data from dozens of states, and surgical injuries are among the many measures used to gauge quality and patient safety in hospitals.

Agency software risk-adjusts accidental punctures and lacerations for each hospital to create a risk-adjusted rate. The rate at each hospital then can be fairly compared with the national rate.

The software determines the statistical significance of the difference between the hospital’s risk-adjusted rate and the national rate. That rules out the likelihood that a finding is inconsequential, or happened by chance.

The billing records are not the same as medical records, so it is impossible for the Sun to determine how a surgical injury affected a patient’s health. It is possible that the doctor immediately identified the injury and repaired it, resulting in no lasting damage.

The trends identified by the Sun are a starting point for further investigation of the medical records, not an end.

In keeping with Agency for Healthcare Research and Quality methods, only medical and surgical discharges over age 18 were examined, excluding patients who had spinal procedures. For more information about the methods, see documents at lasvegassun.com.

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