Summary
Objectives: Errors in the registration or extraction of patient outcome data, such as in-hospital
mortality, may lower the reliability of the quality indicator that uses this (partly)
incorrect data. Our aim was to measure the reliability of in-hospital mortality registration
in the Dutch National Intensive Care Evaluation (NICE) registry.
Methods: We linked data of the NICE registry with an insurance claims database, resulting
in a list of discrepancies in in-hospital mortality. Eleven Intensive Care Units (ICUs)
were visited where local data sources were investigated to find the true in-hospital
mortality status of the discrepancies and to identify the causes of the data errors
in the NICE registry. Original and corrected Stand -ardized Mortality Ratios (SMRs)
were calculated to determine if conclusions about quality of care changed compared
to the national benchmark.
Results: In eleven ICUs, 23,855 records with 460 discrepancies were identified of which 255
discrepancies (1.1% of all linked records) were due to incorrect in-hospital mortality
registration in the NICE registry. Two programming errors in computer software of
six ICUs caused 78% of errors, the remainder was caused by manual transcription errors
and failure to record patient outcomes. For one ICU the performance became concordant
with the national benchmark after correction, instead of being better.
Conclusions: The reliability of in-hospital mortality registration in the NICE registry was good.
This was reflected by the low number of data errors and by the fact that conclusions
about the quality of care were only affected for one ICU due to systematic data errors.
We recommend that registries frequently verify the software used in the registration
process, and compare mortality data with an external source to assure consistent quality
of data.
Keywords
Quality assurance - root cause analysis - hospital mortality - registries - risk adjustment
