Re: Concerns about statistical methods.
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Animals↗
Biomedical subjects
D Hitchin
Publications and source records attributed to D Hitchin.
An orthopaedic theatre timings survey.
The efficient use of operating lists is important to clear waiting lists and because they are expensive to run (at 1988 prices, 151 pounds per hour). Of general surgical theatre session time, 49% is used for performing operations, but no survey of orthopaedic theatre sessions has been published. In light of this we surveyed 151 elective orthopaedic lists at three hospitals. Our aims were to determine the use of operating rooms and the reasons for inefficient use of time. We found 60% of elective list time was used for operating and 21% for turnover. No useful activity occurred during the remaining 19% of theatre time. An average start delay of 26.5 min and average early finish of 14.5 min contributed to this. Only 9/151 (6%) of lists started within 5 min of the scheduled time. Of unnecessary delays contributing to this, 63% involved anaesthetic staff and 24% theatre staff. Surgeons were implicated in 10% of start delays. There were less start delays if senior anaesthetic staff were present. During lists, turnover times were quicker if a consultant surgeon was present (P = 0.0022). We conclude that more efficient use of elective orthopaedic theatre sessions is possible and could be achieved if more detailed preparation was undertaken by the anaesthetic, theatre and surgical staff concerned. If a consultant surgeon is present the list is likely to proceed with fewer delays.
Anesthesiology↗
Who should code orthopaedic inpatients? A comparison of junior hospital doctors and coding clerks.
Our principal aim was to determine whether coding for billing purposes is adequately completed by hospital doctors. We also wanted to determine whether events during the inpatient stay prompted coding. We investigated the completeness and accuracy of ICD9 and OPCS4 coding at two departments of orthopaedics. Coding was for billing purposes only; retrieval of clinical data was limited to individual cases. Junior Hospital Doctors (JHDs) undertook coding at one department, coding clerks at the other. At each side 100 sets of notes concerning inpatient admissions were reviewed. Coding clerks returned coding data of higher completeness and quality (completeness x accuracy) than JHDs, but of lower accuracy. Completeness of data from JHDs reflected motivation to code and this was influenced by events during the course of admission. JHDs coded best for patients undergoing elective surgery, and worst for patients managed non-operatively. Coding clerks coded for all groups equally well. In the current study coding data returned by JHDs was of lower completeness and accuracy than has been described for other coding systems. We attribute the lower completeness to the low motivation of JHDs when coding for billing purposes and the lower accuracy to difficulty in using the system. Motivation could be increased by incorporating coding into departmental audit, the generation of discharge summaries and record collection for personal logbooks.
Abstracting and Indexing↗
Markers of data quality in computer audit: the Manchester Orthopaedic Database.
This study investigates the efficiency of the Manchester Orthopaedic Database (MOD), a computer software package for record collection and audit. Data is entered into the system in the form of diagnostic, operative and complication keywords. We have calculated the completeness, accuracy and quality (completeness x accuracy) of keyword data in the MOD in two departments of orthopaedics (Departments A and B). In each department, 100 sets of inpatient notes were reviewed. Department B obtained results which were significantly better than those in A at the 5% level. We attribute this to the presence of a systems coordinator to motivate and organise the team for audit. Senior and junior staff did not differ significantly with respect to completeness, accuracy and quality measures, but locum junior staff recorded data with a quality of 0%. Statistically, the biggest difference between the departments was the quality of operation keywords. Sample sizes were too small to permit effective statistical comparisons between the quality of complication keywords. In both departments, however, the poorest quality data was seen in complication keywords. The low complication keyword completeness contributed to this; on average, the true complication rate (39%) was twice the recorded complication rate (17%). In the recent Royal College of Surgeons of England Confidential Comparative Audit, the recorded complication rate was 4.7%. In the light of the above findings, we suggest that the true complication rate of the RCS CCA should approach 9%.
Data Collection↗