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A Case for Improving Measurement of Intraoperative Iatrogenic Injuries

Jennifer L. Paruch, MD1,2; Clifford Y. Ko, MD, MS, MSHS1,3,4; Karl Y. Bilimoria, MD, MS1,5
[+] Author Affiliations
1Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
2Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
3Department of Surgery, UCLA (University of California, Los Angeles)
4VA Greater Los Angeles Healthcare System, Los Angeles, California
5Surgical Outcomes and Quality Improvement, Department of Surgery and Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Surg. 2014;149(9):887-888. doi:10.1001/jamasurg.2013.5237.
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Patients, payers, and policy organizations have demonstrated a significant interest in using intraoperative iatrogenic injury as a quality measure. These complications are high-profile and controversial measures of patient safety because they are often discreet occurrences that can be attributed to a specific encounter or physician, and they are events that the public largely perceives as preventable. However, efforts to use intraoperative iatrogenic injury as an outcome measure for either quality improvement or profiling physicians have been limited by problems with the Agency for Healthcare Research and Quality’s (AHRQ) patient safety indicator (PSI)–15 for accidental puncture and laceration, resulting in widespread objection from the surgical community.

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