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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">ReCAP: Detection of Potentially Avoidable Harm in Oncology From Patient Medical Records</title><author><name sortKey="Lipitz Snyderman, Allison" sort="Lipitz Snyderman, Allison" uniqKey="Lipitz Snyderman A" first="Allison" last="Lipitz-Snyderman">Allison Lipitz-Snyderman</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Weingart, Saul N" sort="Weingart, Saul N" uniqKey="Weingart S" first="Saul N." last="Weingart">Saul N. Weingart</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Anderson, Christopher" sort="Anderson, Christopher" uniqKey="Anderson C" first="Christopher" last="Anderson">Christopher Anderson</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Epstein, Andrew S" sort="Epstein, Andrew S" uniqKey="Epstein A" first="Andrew S." last="Epstein">Andrew S. Epstein</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Killen, Aileen" sort="Killen, Aileen" uniqKey="Killen A" first="Aileen" last="Killen">Aileen Killen</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Classen, David" sort="Classen, David" uniqKey="Classen D" first="David" last="Classen">David Classen</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Sima, Camelia S" sort="Sima, Camelia S" uniqKey="Sima C" first="Camelia S." last="Sima">Camelia S. Sima</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Fortier, Elizabeth" sort="Fortier, Elizabeth" uniqKey="Fortier E" first="Elizabeth" last="Fortier">Elizabeth Fortier</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Atoria, Coral L" sort="Atoria, Coral L" uniqKey="Atoria C" first="Coral L." last="Atoria">Coral L. Atoria</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Pfister, David" sort="Pfister, David" uniqKey="Pfister D" first="David" last="Pfister">David Pfister</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26869656</idno><idno type="pmc">5486447</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486447</idno><idno type="RBID">PMC:5486447</idno><idno type="doi">10.1200/JOP.2015.006874</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002F76</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002F76</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">ReCAP: Detection of Potentially Avoidable Harm in Oncology From Patient Medical Records</title><author><name sortKey="Lipitz Snyderman, Allison" sort="Lipitz Snyderman, Allison" uniqKey="Lipitz Snyderman A" first="Allison" last="Lipitz-Snyderman">Allison Lipitz-Snyderman</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Weingart, Saul N" sort="Weingart, Saul N" uniqKey="Weingart S" first="Saul N." last="Weingart">Saul N. Weingart</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Anderson, Christopher" sort="Anderson, Christopher" uniqKey="Anderson C" first="Christopher" last="Anderson">Christopher Anderson</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Epstein, Andrew S" sort="Epstein, Andrew S" uniqKey="Epstein A" first="Andrew S." last="Epstein">Andrew S. Epstein</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Killen, Aileen" sort="Killen, Aileen" uniqKey="Killen A" first="Aileen" last="Killen">Aileen Killen</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Classen, David" sort="Classen, David" uniqKey="Classen D" first="David" last="Classen">David Classen</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Sima, Camelia S" sort="Sima, Camelia S" uniqKey="Sima C" first="Camelia S." last="Sima">Camelia S. Sima</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Fortier, Elizabeth" sort="Fortier, Elizabeth" uniqKey="Fortier E" first="Elizabeth" last="Fortier">Elizabeth Fortier</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Atoria, Coral L" sort="Atoria, Coral L" uniqKey="Atoria C" first="Coral L." last="Atoria">Coral L. Atoria</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Pfister, David" sort="Pfister, David" uniqKey="Pfister D" first="David" last="Pfister">David Pfister</name><affiliation><nlm:aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Oncology Practice</title><idno type="ISSN">1554-7477</idno><idno type="eISSN">1935-469X</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>QUESTION ASKED:</title><p>Although medical record–based measurement of adverse events (AEs) associated with cancer care is desirable, condition-specific triggers in oncology care are needed. We sought to develop a screening tool to facilitate efficient detection of AEs across settings of cancer care via medical record review. We hope to use this tool to understand the frequency, spectrum, and preventability of AEs with the goal of helping improve the quality and safety of cancer care.</p></sec><sec><title>SUMMARY ANSWER:</title><p>We developed a cancer-specific screening tool to help identify candidate preventable AEs that occur during cancer care from patients’ medical records. Our oncology screening tool consists of 76 triggers—readily identifiable findings to screen for possible AEs that occur during cancer care (<xref ref-type="table" rid="T01">Table 1</xref>).</p></sec><sec><title>METHODS:</title><p>We sought to develop a screening tool to facilitate the detection of AEs across settings of cancer care via medical record review. We obtained structured and unstructured input from clinical experts to develop our tool, using a modified Delphi process.</p></sec><sec><title>BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:</title><p>Our oncology tool requires further evaluation in order to understand its usefulness for population-based assessments of AEs in oncology and quality improvement.</p></sec><sec><title>REAL-LIFE IMPLICATIONS:</title><p>Information obtained from structured record reviews using an oncology trigger tool could help to prioritize quality improvement activities, identify high-risk groups, and generate cancer-focused quality measures. Ultimately, the goals of this work are to prevent AEs and allow timely, automated identification of these events so that clinicians can intervene promptly to improve patient outcomes.</p><table-wrap id="T01" position="float"><label>Table 1.</label><caption><p>Memorial Sloan Kettering Cancer Center Oncology Trigger Tool</p></caption><alternatives><graphic xlink:href="JOPR006874t01"></graphic><table frame="hsides" rules="groups"><col width="20.81%" span="1"></col><col width="79.19%" span="1"></col><thead><tr><th valign="top" align="left" scope="col" rowspan="1" colspan="1"></th><th valign="bottom" align="left" scope="col" rowspan="1" colspan="1">Trigger</th></tr></thead><tbody><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Laboratory</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Adrenal function studies<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal phosphate (> 5, < 1.5 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum bicarbonate (< 18, > 36 mEq/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum bilirubin (> 2 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum calcium (> 12, < 7 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum magnesium (> 4, < 1.5 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L7</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum potassium (> 6, < 2.5 mEq/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L8</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum sodium (> 150, < 130 mEq/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L9</td><td valign="bottom" align="left" rowspan="1" colspan="1">Arterial blood gas (not in PACU/ICU)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L10</td><td valign="bottom" align="left" rowspan="1" colspan="1">Bladder catheter and positive urine culture<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L11</td><td valign="bottom" align="left" rowspan="1" colspan="1">BNP (> 400 pg/mL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L12</td><td valign="bottom" align="left" rowspan="1" colspan="1"><italic>Clostridium difficile</italic> toxin positive<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L13</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated AST (> 300 units/L) or ALT (> 300 units/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L14</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated blood glucose (> 250 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L15</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated creatinine > 1 mg/dL and 50% greater than baseline<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L16</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated INR (> 8)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L17</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated lipase (> 160 U/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L18</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated serum uric acid (> 10 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L19</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated troponin (> 0.64 ng/mL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L20</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated TSH (> 10 mcU/mL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L21</td><td valign="bottom" align="left" rowspan="1" colspan="1">Low fibrinogen (< 100 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L22</td><td valign="bottom" align="left" rowspan="1" colspan="1">Neutropenic fever (except in patients with leukemia or bone marrow transplant)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L23</td><td valign="bottom" align="left" rowspan="1" colspan="1">Platelet count < 20,000 (except in patients with leukemia or bone marrow transplant)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L24</td><td valign="bottom" align="left" rowspan="1" colspan="1">Positive blood culture without contaminant (eg, <italic>Staphylococcus epidermidis</italic>)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L25</td><td valign="bottom" align="left" rowspan="1" colspan="1">Tylenol blood level<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Orders</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Acute inpatient dialysis</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Blood transfusion</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Cardiac defibrillator</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Chest x-ray in inpatient or urgent care center</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Contact precautions/order for isolation</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Fistulogram/sinogram</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R7</td><td valign="bottom" align="left" rowspan="1" colspan="1">High-dose intravenous proton pump inhibitor (omeprazole, esomeprazole, and pantoprazole 80-mg bolus followed by 8 mg/h infusion)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R8</td><td valign="bottom" align="left" rowspan="1" colspan="1">ICU transfer from floor</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R9</td><td valign="bottom" align="left" rowspan="1" colspan="1">Nasogastric tube (not in operating room)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R10</td><td valign="bottom" align="left" rowspan="1" colspan="1">Noncontrast chest CT scan after radiation to the chest</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R11</td><td valign="bottom" align="left" rowspan="1" colspan="1">Percutaneous drain placement</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R12</td><td valign="bottom" align="left" rowspan="1" colspan="1">Platelet transfusion (except in patients with leukemia or bone marrow transplant)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R13</td><td valign="bottom" align="left" rowspan="1" colspan="1">Positive bone imaging test (plain films, CT scans)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R14</td><td valign="bottom" align="left" rowspan="1" colspan="1">Positive lower-extremity ultrasound</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R15</td><td valign="bottom" align="left" rowspan="1" colspan="1">Positive upper-extremity ultrasound</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R16</td><td valign="bottom" align="left" rowspan="1" colspan="1">Rapid response team</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R17</td><td valign="bottom" align="left" rowspan="1" colspan="1">Reintubation</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R18</td><td valign="bottom" align="left" rowspan="1" colspan="1">Steroid enema</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R19</td><td valign="bottom" align="left" rowspan="1" colspan="1">Use of pressors</td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Consultations</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Inpatient cardiology consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Inpatient gastroenterology consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Inpatient or outpatient IR consult (excluding referral for port placement)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Inpatient surgery consult for nonsurgical patients<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Lymphedema consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Nephrology consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C7</td><td valign="bottom" align="left" rowspan="1" colspan="1">Neurology consult and noncontrast head CT scan<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C8</td><td valign="bottom" align="left" rowspan="1" colspan="1">Sitter and inpatient psychiatric consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">General care</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Death in hospital</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Extravasation</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Fall</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Hospital readmission/urgent care visit within 72 h of hospital discharge or ambulatory surgery</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Low urine output (< 30 mL/h)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Pressure ulcer</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G7</td><td valign="bottom" align="left" rowspan="1" colspan="1">Return to the operating room or IR within 30 days of surgery</td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Vital signs</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> V1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Blood pressure (> 200/100 mmHg)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> V2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Low oximetry results (Sa<sc>o</sc><sub>2</sub> < 88%)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> V3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Pain score (≥ 7)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> V4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Temperature (< 35°C perioperatively)</td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Medication related</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Epinephrine<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Flumazenil, glucagon, naloxone, protamine<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Initiation of therapeutic anticoagulation<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Intravascular thrombolytic therapy<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Kayexalate<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Methylnaltrexone<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M7</td><td valign="bottom" align="left" rowspan="1" colspan="1">Octreotide<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M8</td><td valign="bottom" align="left" rowspan="1" colspan="1">Oral anesthetics (eg, Magic Mouthwash, viscous lidocaine)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M9</td><td valign="bottom" align="left" rowspan="1" colspan="1">Sodium thiosulfate, hyaluronidase, topical dimethylsulfoxide, dexrazoxane, phentolamine<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M10</td><td valign="bottom" align="left" rowspan="1" colspan="1">Total parenteral nutrition<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M11</td><td valign="bottom" align="left" rowspan="1" colspan="1">Use of intravenous glucose or dextrose<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M12</td><td valign="bottom" align="left" rowspan="1" colspan="1">Use of more than three doses of antiemetics within 24 h<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M13</td><td valign="bottom" align="left" rowspan="1" colspan="1">Vitamin K<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr></tbody></table></alternatives><table-wrap-foot><fn fn-type="abbr"><p>Abbreviations: BNP, brain natriuretic peptide; CT, computed tomography; ICU, intensive care unit; INR, international normalized ratio; IR, interventional radiology; PACU, postanesthesia care unit; Sa<sc>o</sc><sub>2</sub>, arterial oxygen saturation; TSH, thyroid-stimulating hormone.</p></fn><fn id="t01n1"><label>*</label><p>Triggers have been automated in the pilot study at Memorial Sloan Kettering Cancer Center.</p></fn></table-wrap-foot></table-wrap></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Oncol Pract</journal-id><journal-id journal-id-type="iso-abbrev">J Oncol Pract</journal-id><journal-id journal-id-type="hwp">jop</journal-id><journal-id journal-id-type="pmc">jop</journal-id><journal-id journal-id-type="publisher-id">J Onc Prac</journal-id><journal-title-group><journal-title>Journal of Oncology Practice</journal-title></journal-title-group><issn pub-type="ppub">1554-7477</issn><issn pub-type="epub">1935-469X</issn><publisher><publisher-name>American Society of Clinical Oncology</publisher-name><publisher-loc>Alexandria, VA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26869656</article-id><article-id pub-id-type="pmc">5486447</article-id><article-id pub-id-type="publisher-id">006874</article-id><article-id pub-id-type="doi">10.1200/JOP.2015.006874</article-id><article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>13</subject><subject>16</subject><subject>17</subject><subject>Hsr2</subject><subject>146</subject></subj-group><subj-group subj-group-type="heading"><subject>Original Contributions</subject><subj-group><subject>Focus on Quality</subject></subj-group></subj-group></article-categories><title-group><article-title>ReCAP: Detection of Potentially Avoidable Harm in Oncology From Patient Medical Records</article-title><alt-title alt-title-type="short">Detection of Harm in Oncology From Medical Records</alt-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Lipitz-Snyderman</surname><given-names>Allison</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Weingart</surname><given-names>Saul N.</given-names></name><degrees>MD, MPP, PhD</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Anderson</surname><given-names>Christopher</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Epstein</surname><given-names>Andrew S.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Killen</surname><given-names>Aileen</given-names></name><degrees>RN, PhD, CPPS</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Classen</surname><given-names>David</given-names></name><degrees>MD, MS</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Sima</surname><given-names>Camelia S.</given-names></name><degrees>MD, MS</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Fortier</surname><given-names>Elizabeth</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Atoria</surname><given-names>Coral L.</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Pfister</surname><given-names>David</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1"></xref></contrib><aff id="aff1">Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA</aff></contrib-group><author-notes><corresp id="cor1">Corresponding author: Allison Lipitz-Snyderman, PhD, <addr-line>Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2nd Floor, New York, NY 10017</addr-line>; email: <email>snyderma@mskcc.org</email>.</corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>10</month><year>2016</year></pub-date><pmc-comment> PMC Release delay is 8 months and
0 days and was based on the
<volume>12</volume><issue>2</issue><fpage>178</fpage><lpage>179</lpage><permissions><copyright-statement>Copyright © 2016 by American Society of Clinical Oncology</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>American Society of Clinical Oncology</copyright-holder></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="JOPR006874.pdf"></self-uri><abstract><sec><title>QUESTION ASKED:</title><p>Although medical record–based measurement of adverse events (AEs) associated with cancer care is desirable, condition-specific triggers in oncology care are needed. We sought to develop a screening tool to facilitate efficient detection of AEs across settings of cancer care via medical record review. We hope to use this tool to understand the frequency, spectrum, and preventability of AEs with the goal of helping improve the quality and safety of cancer care.</p></sec><sec><title>SUMMARY ANSWER:</title><p>We developed a cancer-specific screening tool to help identify candidate preventable AEs that occur during cancer care from patients’ medical records. Our oncology screening tool consists of 76 triggers—readily identifiable findings to screen for possible AEs that occur during cancer care (<xref ref-type="table" rid="T01">Table 1</xref>).</p></sec><sec><title>METHODS:</title><p>We sought to develop a screening tool to facilitate the detection of AEs across settings of cancer care via medical record review. We obtained structured and unstructured input from clinical experts to develop our tool, using a modified Delphi process.</p></sec><sec><title>BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:</title><p>Our oncology tool requires further evaluation in order to understand its usefulness for population-based assessments of AEs in oncology and quality improvement.</p></sec><sec><title>REAL-LIFE IMPLICATIONS:</title><p>Information obtained from structured record reviews using an oncology trigger tool could help to prioritize quality improvement activities, identify high-risk groups, and generate cancer-focused quality measures. Ultimately, the goals of this work are to prevent AEs and allow timely, automated identification of these events so that clinicians can intervene promptly to improve patient outcomes.</p><table-wrap id="T01" position="float"><label>Table 1.</label><caption><p>Memorial Sloan Kettering Cancer Center Oncology Trigger Tool</p></caption><alternatives><graphic xlink:href="JOPR006874t01"></graphic><table frame="hsides" rules="groups"><col width="20.81%" span="1"></col><col width="79.19%" span="1"></col><thead><tr><th valign="top" align="left" scope="col" rowspan="1" colspan="1"></th><th valign="bottom" align="left" scope="col" rowspan="1" colspan="1">Trigger</th></tr></thead><tbody><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Laboratory</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Adrenal function studies<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal phosphate (> 5, < 1.5 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum bicarbonate (< 18, > 36 mEq/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum bilirubin (> 2 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum calcium (> 12, < 7 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum magnesium (> 4, < 1.5 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L7</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum potassium (> 6, < 2.5 mEq/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L8</td><td valign="bottom" align="left" rowspan="1" colspan="1">Abnormal serum sodium (> 150, < 130 mEq/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L9</td><td valign="bottom" align="left" rowspan="1" colspan="1">Arterial blood gas (not in PACU/ICU)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L10</td><td valign="bottom" align="left" rowspan="1" colspan="1">Bladder catheter and positive urine culture<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L11</td><td valign="bottom" align="left" rowspan="1" colspan="1">BNP (> 400 pg/mL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L12</td><td valign="bottom" align="left" rowspan="1" colspan="1"><italic>Clostridium difficile</italic> toxin positive<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L13</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated AST (> 300 units/L) or ALT (> 300 units/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L14</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated blood glucose (> 250 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L15</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated creatinine > 1 mg/dL and 50% greater than baseline<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L16</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated INR (> 8)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L17</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated lipase (> 160 U/L)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L18</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated serum uric acid (> 10 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L19</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated troponin (> 0.64 ng/mL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L20</td><td valign="bottom" align="left" rowspan="1" colspan="1">Elevated TSH (> 10 mcU/mL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L21</td><td valign="bottom" align="left" rowspan="1" colspan="1">Low fibrinogen (< 100 mg/dL)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L22</td><td valign="bottom" align="left" rowspan="1" colspan="1">Neutropenic fever (except in patients with leukemia or bone marrow transplant)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L23</td><td valign="bottom" align="left" rowspan="1" colspan="1">Platelet count < 20,000 (except in patients with leukemia or bone marrow transplant)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L24</td><td valign="bottom" align="left" rowspan="1" colspan="1">Positive blood culture without contaminant (eg, <italic>Staphylococcus epidermidis</italic>)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> L25</td><td valign="bottom" align="left" rowspan="1" colspan="1">Tylenol blood level<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Orders</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Acute inpatient dialysis</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Blood transfusion</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Cardiac defibrillator</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Chest x-ray in inpatient or urgent care center</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Contact precautions/order for isolation</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Fistulogram/sinogram</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R7</td><td valign="bottom" align="left" rowspan="1" colspan="1">High-dose intravenous proton pump inhibitor (omeprazole, esomeprazole, and pantoprazole 80-mg bolus followed by 8 mg/h infusion)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R8</td><td valign="bottom" align="left" rowspan="1" colspan="1">ICU transfer from floor</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R9</td><td valign="bottom" align="left" rowspan="1" colspan="1">Nasogastric tube (not in operating room)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R10</td><td valign="bottom" align="left" rowspan="1" colspan="1">Noncontrast chest CT scan after radiation to the chest</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R11</td><td valign="bottom" align="left" rowspan="1" colspan="1">Percutaneous drain placement</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R12</td><td valign="bottom" align="left" rowspan="1" colspan="1">Platelet transfusion (except in patients with leukemia or bone marrow transplant)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R13</td><td valign="bottom" align="left" rowspan="1" colspan="1">Positive bone imaging test (plain films, CT scans)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R14</td><td valign="bottom" align="left" rowspan="1" colspan="1">Positive lower-extremity ultrasound</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R15</td><td valign="bottom" align="left" rowspan="1" colspan="1">Positive upper-extremity ultrasound</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R16</td><td valign="bottom" align="left" rowspan="1" colspan="1">Rapid response team</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R17</td><td valign="bottom" align="left" rowspan="1" colspan="1">Reintubation</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R18</td><td valign="bottom" align="left" rowspan="1" colspan="1">Steroid enema</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> R19</td><td valign="bottom" align="left" rowspan="1" colspan="1">Use of pressors</td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Consultations</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Inpatient cardiology consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Inpatient gastroenterology consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Inpatient or outpatient IR consult (excluding referral for port placement)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Inpatient surgery consult for nonsurgical patients<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Lymphedema consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Nephrology consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C7</td><td valign="bottom" align="left" rowspan="1" colspan="1">Neurology consult and noncontrast head CT scan<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> C8</td><td valign="bottom" align="left" rowspan="1" colspan="1">Sitter and inpatient psychiatric consult<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">General care</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Death in hospital</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Extravasation</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Fall</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Hospital readmission/urgent care visit within 72 h of hospital discharge or ambulatory surgery</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Low urine output (< 30 mL/h)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Pressure ulcer</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> G7</td><td valign="bottom" align="left" rowspan="1" colspan="1">Return to the operating room or IR within 30 days of surgery</td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Vital signs</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> V1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Blood pressure (> 200/100 mmHg)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> V2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Low oximetry results (Sa<sc>o</sc><sub>2</sub> < 88%)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> V3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Pain score (≥ 7)</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> V4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Temperature (< 35°C perioperatively)</td></tr><tr><td valign="top" align="left" scope="col" rowspan="1" colspan="1">Medication related</td><td valign="bottom" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M1</td><td valign="bottom" align="left" rowspan="1" colspan="1">Epinephrine<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M2</td><td valign="bottom" align="left" rowspan="1" colspan="1">Flumazenil, glucagon, naloxone, protamine<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M3</td><td valign="bottom" align="left" rowspan="1" colspan="1">Initiation of therapeutic anticoagulation<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M4</td><td valign="bottom" align="left" rowspan="1" colspan="1">Intravascular thrombolytic therapy<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M5</td><td valign="bottom" align="left" rowspan="1" colspan="1">Kayexalate<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M6</td><td valign="bottom" align="left" rowspan="1" colspan="1">Methylnaltrexone<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M7</td><td valign="bottom" align="left" rowspan="1" colspan="1">Octreotide<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M8</td><td valign="bottom" align="left" rowspan="1" colspan="1">Oral anesthetics (eg, Magic Mouthwash, viscous lidocaine)<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M9</td><td valign="bottom" align="left" rowspan="1" colspan="1">Sodium thiosulfate, hyaluronidase, topical dimethylsulfoxide, dexrazoxane, phentolamine<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M10</td><td valign="bottom" align="left" rowspan="1" colspan="1">Total parenteral nutrition<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M11</td><td valign="bottom" align="left" rowspan="1" colspan="1">Use of intravenous glucose or dextrose<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M12</td><td valign="bottom" align="left" rowspan="1" colspan="1">Use of more than three doses of antiemetics within 24 h<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> M13</td><td valign="bottom" align="left" rowspan="1" colspan="1">Vitamin K<xref ref-type="table-fn" rid="t01n1">*</xref></td></tr></tbody></table></alternatives><table-wrap-foot><fn fn-type="abbr"><p>Abbreviations: BNP, brain natriuretic peptide; CT, computed tomography; ICU, intensive care unit; INR, international normalized ratio; IR, interventional radiology; PACU, postanesthesia care unit; Sa<sc>o</sc><sub>2</sub>, arterial oxygen saturation; TSH, thyroid-stimulating hormone.</p></fn><fn id="t01n1"><label>*</label><p>Triggers have been automated in the pilot study at Memorial Sloan Kettering Cancer Center.</p></fn></table-wrap-foot></table-wrap></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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