Validity of anaesthetic complication coding data as a clinical indicator
Andrew Jones A , John P. Monagle A B , Susan Peel A , Matthew W. Coghlan A , Vangy Malkoutzis A and Andrea Groom AA Southern Health, 246 Clayton Road, Clayton, VIC 3168, Australia. Email: andrewjones@sctelco.net.au, susan.peel@southernhealth.org.au, matthew.coghlan@southernhealth.org.au, vangy.malkoutzis@southernhealth.org.au, andrea.groom@southernhealth.org.au
B Corresponding author. Email: john.monagle@southernhealth.org.au
Australian Health Review 36(2) 229-232 https://doi.org/10.1071/AH11004
Submitted: 2 February 2011 Accepted: 14 September 2011 Published: 25 May 2012
Abstract
Clinical indicators using routinely collected International Statistical Classification of Diseases, Australian Modification (ICD–10–AM) data offer promise as tools for improvement of quality. The ICD–10–AM is the coding system used by Australian administrators to summarise information from the clinical record to describe a patient’s hospital encounter. The use of anaesthesia complications as coded by this system has been proposed by two jurisdictions as a monitor of the quality of anaesthetic services.
We undertook a review of cases identified by such indicators in a large tertiary hospital. Our results indicate the anaesthesia indicator dataset proposed by the Victorian and Queensland Health departments appears to have little clinical or quality improvement relevance.
What is known about the topic? Quality assurance relies on reviewing performance, highlighting issues and eliminating or minimising the identified risks. Case or risk identification in the medical arena relies heavily on self reporting, which has many flaws. A system not dependent on self reporting that was reliable would be a positive development in the pursuit of quality improvement.
What does this paper add? ICD-AM-10 coding was used to identify complications attributable to anaesthesia as defined by the coding system. The cases identified were then reviewed for the clinical accuracy of this information. The clinical coding was accurate, but the clinical case load so identified did not accurately reflect real incidents of anaesthesia-related complications. The ICD AM 10 codes, as they relate to anaesthesia complications, do not provide a reliable method of identifying cases that contribute to anaesthetic quality assurance activities.
What are the implications for practitioners? Anaesthesia quality assurance continues to be dependent on self reporting of relevant cases. Coded data do not provide an adequate substitute for the self reporting mechanisms.
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