Case record review

Studying adverse events using case record review... 

Neale, G. and Woloshynowych, M. (2003) Retrospective case record review a blunt instrument that needs sharpening. Quality and Safety in Health Care, 12(1), 2-3. 

Reporting systems in healthcare were established in response to the scale of harm revealed by case record review studies. The studies had shown the underlying problem reporting systems were meant to provide information about adverse events on an ongoing basis. Do reporting systems actually capture adverse events successfully A number of studies have now examined this issue, coming to broadly similar conclusions (Stanhope et al., 1999 Sari et al, 2007 Blais et al, 2008). As an example, we will consider the study... 

There is no need to implement an audit trail for the parameter settings, but the completeness of the logbook entries must be ensured, e.g., via double check and/or additional training of the employees. Nevertheless, the data in the monitoring system must be assessed regarding their Part 11 relevance. In this case all data are printed, and the printout is used for the batch record review. There is no further regulated activity based on the electronic data... 

Claims that cases of encephalopathy followed by permanent brain injury or death were due to measles immunization, submitted to the US National Vaccine Injury Compensation Program, have been reviewed (SED-13, 920) (18). A total of 403 claims of encephalopathy and/or seizure disorders after measles, measles-rubella, measles-mumps-rubella, mumps, or rubella immunization were identified during the period 1970-93. The medical records of these cases were reviewed by physicians in the compensation program to determine, if possible, the cause of injury and the classification of the findings. The inclusion criteria established by the compensation program were met by... 

Some records must be retained for specified periods by law. In any case, records should be reviewed periodically to identify repetitive failures which might suggest the need for revised maintenance or design, or more frequent inspections and tests. Conversely, continuously satisfactory results might justify increasing the interval between inspections and tests, subject to statutory requirements. Reliability-based maintenance techniques are valuable tools in this area. 

More lasting or permanent effects may occur when CN is released at close range (within a few meters), particularly if it is from a forceful blast from a cartridge, bomb, pistol, or spray. One study40 based on case records from the files of the Armed Forces Institute of Pathology in Washington, D. C., reviewed eye injuries from tear gas unfortunately, many of the histories were incomplete. In about half the cases, the injuries were self-inflicted and accidental in the other half, the injuries were caused by a second person firing a... 

Ingestion of "large amounts" of orange peel (bitter or sweet) has been reported to cause intestinal colic, convulsions, and even death in children (Leung and Foster 1996). A review of this reference and its sources, however, discloses that the reported death was limited to a single case recorded in 1833 that was attributed to "eating the rind of an orange," and that no additional details were provided on the other reported effects (Wood and Bache 1833). The current literature does not indicate any concern for such events at standard therapeutic doses. 

The basic record review process is as follows. In phase I, nurses or experienced record clerks are trained to identify case records that satisfy one or more of 18 well-defined screening criteria - such as death, transfer to a special care unit or re-admission to hospital within 12 months. These have been shown to be associated with an increased likelihood of an adverse event (Neale and Woloshynowych, 2003). In phase II, trained doctors analyse positively screened records in detail to determine whether or not they contain evidence of an adverse event using a standard set of questions. The basic method has been followed in all the major national studies, though modifications of the review form and data capture have been developed (Woloshynowych, Neale and Vincent, 2003). In France, Phillipe Michel used prospeaive review, in the sense that record review is carried out close to the time of discharge on a... 

Case note review is sometimes viewed as time consuming and comparatively expensive. Nevertheless, with experience and refinement and the development of training packages (Olsen et al 2007), it can be carried out relatively inexpensively, producing systematic, detailed analyses. A few organizations, such as Royal North Shore in Sydney (Harrison, personal communication) carry out formal, annual case note reviews and use these as the basis of their quality assurance and improvement systems. Record reviews could be repeated over time, and trends studied, particularly as we would now be able to define and monitor specific types of adverse events rather than just assess the overall rates. Reliability and validity of judgement of adverse events is not as good as we would wish but could certainly be improved if specific definitions of particular classes of adverse events were developed. 

During an investigation, information is gleaned from a variety of sources. Case records, statements and any other relevant documentation are reviewed. 

Record review revealed a by now familiar finding 11 % of patients suffered an adverse event, with about a tenth (11 cases) of these being serious and preventable. However, 23% of patients reported an adverse event and there was little concordance between the two methods. Patient reports revealed an additional 21 serious and preventable events (Table 15.1), in addition to the 11 found in medical records, thus tripling the rate revealed by record review. The true rate of incidents potentially reportable by patients may be higher still, as some interviews took place several months after discharge and patients who died or were very sick post discharge were excluded from the study. As the examples show, many of the incidents reported by patients were serious untoward events that should have been described in the medical record. 

Health and safety arrangements Employers are required to make, give effect to and in certain cases record appropriate health and safety arrangements. These arrangements should cover planning, organisation, control, monitoring and review of preventive and protective measures. 

J. Chem. Educ., 1969,46, A171 Hydrofluoric Acid Bum Treatment . The treatment of HF burns has bwn in a state of flux in the past, with numerous remedies being tried. This presentation offers a somewhat different approach which centres around the use of certain high-molecular-weight quaternary ammonium compounds. The treatment consists basically in thorough and immediate flushing with water, followed by iced alcohol or aqueous Hyamine soaks. A review of over 200 case records confirms the efficacy of this treatment when compared with that in prior use, especially in the treatment of second-degree bums. 

The main objective of the In-Plant Reliability Data System (IPRDS) was to develop a comprehensive and component-specific data base for PRA and other component reliability-related statistical analysis. Data base personnel visited selected plants and copied all the plant maintenance wor)c requests. They also gathered plant equipment lists and plant drawings and in some cases interviewed plant personnel for Information on component populations and duty cycles. Subsequently, the maintenance records were screened to separate out the cases of corrective maintenance applying to particular components these were reviewed to determine such things as failure modes, severity, and, if possible, failure cause. The data from these reports were encoded into a computerized data base. 

Once it is determined that data exist, the next step is to begin the collection process. If sufficient thought and training is provided in the development and operation of the maintenance and operating reporting systems, much of the collection process can be automated. Automation assumes that a well-thought-out taxonomy is in place. If this is not the case, then an analyst must collect and review the records manually. In either case, the analyst must collect data from the plant sources previously discussed in order to determine the numerator (number of failures within a unique plant equipment population), and denominator (the operating time or number of demands for the equipment) of the equation to calculate failure rates. 

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