Table 1 Data sources and criteria for determining adverse event (AE) occurrence
Adverse event | Database | Method for detecting | Criteria assessed >48Â h after hospital admission (HAP, CVC-BSI) or initiation of mechanical ventilation (VAP) |
|---|---|---|---|
HAP/VAP | Radiology | NLP | A chest radiograph that is suggestive of a) a new, progressive or persistent infiltrate; b) consolidation; or c) cavitation |
Microbiology | Query/rule | Qualitative and quantitative reports of sputum cultures suggestive of the presence of HAP or VAP (e.g. Gram stain of respiratory secretions sample with ≥25 neutrophils and ≤10 squamous epithelial cells per high power field) | |
Laboratory | Query/rule | Evidence of leukopenia (WBC < 4,000/mm3), leukocytosis (WBC > 12,000/mm3) or abnormal trends in the WBC | |
Vital signs | Query/rule | Patient body temperature >38°C or abnormal trends in elevated body temperatures; Worsening gas exchanges (e.g. O2 desaturations, increased oxygen requirements, increased ventilator demand [⬆FiO2 of ≥ 0.2 point or⬆PEEP values of ≥ 3cmH2O compared to previous 48 h and sustained for 48 h) | |
Progress notes | NLP | Evidence of altered mental status in patients ≥70 years old | |
Pharmacy | Query/rule | Prescription of a new antimicrobial agent covering the micro-organisms most commonly causing HAP/VAP, duration and timing of antibiotic exposure [49]. | |
CVC-BSI | Microbiology | Query/rule | Blood cultures that are suggestive of the presence of a CVC-BSI. To exclude cases of secondary BSI, special queries will be constructed to determine if organisms recovered from blood cultures were also recovered from non-blood cultures (e.g. sputum, surgical site or urine cultures). CDC/NHSN rules will be followed to exclude cases of positive blood cultures due to contamination from common skin commensals |
Laboratory | Query/rule | Evidence of leucopenia (WBC < 4,000/mm3), leukocytosis (WBC > 11,000/mm3) or abnormal trends in the WBC | |
Vital signs | Query/rule | Body temperature >38°C or abnormal trends in elevated body temperatures >48 h after hospital admission | |
Pharmacy | Query/rule | Prescription of an antibiotic covering the micro-organisms most commonly causing CVC-BSIs, duration and timing of antibiotic exposure [49] | |
Radiology | NLP | To define the denominator, the radiology database will be consulted to identify chest radiograph reports showing the presence of a CVC [50] | |
Progress notes | NLP | Progress notes suggestive of the presence of a CVC-BSI | |
In-hospital fall | Progress notes | NLP | Progress notes suggestive of an in-hospital fall (e.g. ‘patient found on the floor’, ‘patient fell off the bed’) |
Radiology | NLP | Narrative radiology reports that are suggestive of the occurrence of a fall (e.g. history of fall, s/p fall, syncope). Then, these reports will be scanned for evidence of soft tissue injuries, long bones, hip, wrist or skull fractures or traumatic brain injuries |