Developing a Veterans Health Administration (VHA) Serious Injury Surveillance System that Includes Adverse Event Hospitalizations

Objectives: The objective of this study was to examine the feasibility of applying the State and Territorial Injury Prevention Directors Association (STIPDA) consensus recommendations for using hospital discharge data in injury and adverse event surveillance to the Veterans Health Administration (VHA) population. The utility of developing an injury surveillance system that also included adverse events due to medical care was examined for its potential contributions to VHA patient safety programs and research. Methods: Selected variables from all VHA hospital inpatient discharges for 5 fiscal years (1998- 2002) were extracted from the National Patient Care Dataset. The resultant dataset had more than 2.8 million records. The selected variables extracted included demographic and clinical information. Discharges for injuries and adverse events due to medications and medical complications were identified using the primary admitting diagnosis in accordance with STIPDA recommendations. The injuries and adverse events were grouped into categories using the Clinical Classification Software developed by the Agency for Healthcare Research and Quality (AHRQ). The medical care costs for these injury and adverse event hospital discharges were obtained from the VHA Decision Support System (DSS). Results: Over the study time frame, 153,153 injury and adverse event discharges occurred, with more than 1.8 million inpatient days, and $2.0 billion in direct medical care costs. In any given year, injury and adverse event discharges accounted for approximately 10 percent of total hospital medical costs and approximately 5 percent of the total discharges. Hospitalizations for adverse events associated with medical care, or medication adverse events, represented more than 50 percent of the hospitalizations. Conclusions: VHA administrative hospital discharge datasets can be used following STIPDA recommendations to monitor trends in the incidence and costs of veterans' hospitalizations for injuries as well as adverse events. The information gained from this enhanced injury surveillance system has the potential to positively affect current VHA patient safety and injury prevention initiatives.