Recording adverse events following orthopaedic trauma: Financial implications and validation of an adverse event assessment form in an Irish regional trauma unit

Published:November 09, 2022DOI:


      • Data collection in hospitals using activity-based funding models determines allocation of scarce resources.
      • This data is collected by non-medical staff which may lead to inaccuracies.
      • Even in smaller trauma units significant discrepancies in missed funding occur.



      In Ireland, funding of orthopaedic trauma is based on an activity-based funding (ABF) model. Clinically similar cases are split into diagnostic-related groups (DRG), with base funding per DRG provided. Increased complexity of cases (length of stay; complications incurred; occurrence of adverse events) attracts additional remuneration to the base funding. In our institution these adverse events are recorded via retrospective chart-abstraction methods by administrative staff. Incidences which are not included from this review affect both follow up with family physicians and patient care; as well as skewing budgetary decisions that impact fiscal viability of the service. The aim of this study was to compare a prospectively implemented adverse events form with the current national retrospective chart abstraction method. Our outcomes in terms of pay-by-results financial implications.


      An adverse events database adapted from a similar validated model was used to prospectively record complications in 216 patients admitted via the orthopaedic trauma service. Data was contemporaneously collected via a GDPR compliant secure medical messaging platform. Results were compared with the same cohort using an existing data abstraction method. Both data sets were coded in accordance with current standards for case funding.


      Overall, 49 adverse events were recorded during the study through prospective charting of adverse events, compared with 26 events documented by customary method (p<0.01).Anaemia requiring blood transfusion n = 11 22.4%) was the most common complication, followed by delirium n = 6 (12%), acute kidney injury n = 6 (12%), and pneumonia n = 5 (10.2%). Missed appropriate funding through conventional methods totalled €40,293 .


      This pilot study demonstrates the ability to improve capture of adverse events through use of a well-designed assessment form. Proper perioperative data handling is a critical aspect of financial subsidies, enabling optimal allocation of funds.


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        • Runge J.W.
        The cost of injury.
        Emerg Med Clin North Am. 1993; 11: 241-253
        • Holbrook T.L.
        • Hoyt D.B.
        • Anderson J.P.
        The impact of major in-hospital complications on functional outcome and quality of life after trauma.
        J Trauma. 2001; 50: 91-95
        • Baron S.
        • Duclos C.
        • Thoreux P.
        Orthopedics coding and funding.
        Orthop Traumatol Surg Res. 2014; 100: S99-106
        • Arabian S.S.
        • Marcus M.
        • Captain K.
        • Pomphrey M.
        • Breeze J.
        • Wolfe J.
        • et al.
        Variability in interhospital trauma data coding and scoring: a challenge to the accuracy of aggregated trauma registries.
        J Trauma Acute Care Surg. 2015; 79: 359-363
        • Bonne S.
        • Schuerer D.J.
        Trauma in the older adult: epidemiology and evolving geriatric trauma principles.
        Clin Geriatr Med. 2013; 29: 137-150
        • Chen L-T
        • Lee J.A.
        • Chua B.S.
        • Howe T.-.S.
        Hip fractures in the elderly: the impact of comorbid illnesses on hospitalisation costs.
        Annals-Acad Med Singap. 2007; 36: 784
      1. Budget 2022: Minister Donnelly announces €21 billion, the biggest ever investment in Ireland's health and social care services [press release]., 14/10/2021 2021.

        • Ricci M.
        • Goldman A.
        • De Leval M.
        • Cohen G.
        • Devaney F.
        • Carthey J.
        Pitfalls of adverse event reporting in paediatric cardiac intensive care.
        Arch Dis Child. 2004; 89: 856-859
        • Chang A.
        • Schyve P.M.
        • Croteau R.J.
        • O'Leary D.S.
        • Loeb J.M
        The JCAHO patient safety event taxonomy: a standardized terminology and classification schema for near misses and adverse events.
        Int J Qual Health Care. 2005; 17: 95-105
        • Elder N.C.
        • Dovey S.M.
        Classification of medical errors and preventable adverse events in primary care: a synthesis of the literature.
        J Fam Pract. 2002; 51: 927-932
        • Pierluissi E.
        • Fischer M.A.
        • Campbell A.R.
        • Landefeld C.S.
        Discussion of medical errors in morbidity and mortality conferences.
        JAMA. 2003; 290: 2838-2842
        • Wu A.W.
        Medical error: the second victim: the doctor who makes the mistake needs help too.
        Brit Med J Publish Gr. 2000;
      2. Health Research and Information Division EaSRI. Activity in acute public hospitals in Ireland, annual report 2012. 2013 2013-12-10. Contract No.: ISBN:9780707003603.

        • Hunt J.P.
        • Baker C.C.
        • Fakhry S.M.
        • Rutledge R.R.
        • Ransohoff D.
        • Meyer A.A.
        Accuracy of administrative data in trauma.
        Surgery. 1999; 126: 191-197
        • Rampersaud Y.R.
        • Moro E.R.
        • Neary M.A.
        • White K.
        • Lewis S.J.
        • Massicotte E.M.
        • et al.
        Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols.
        Spine. 2006; 31: 1503-1510
        • Rampersaud Y.R.
        • Neary M.A.
        • White K.
        Spine adverse events severity system: content validation and interobserver reliability assessment.
        Spine. 2010; 35: 790-795
        • Karstensen S.
        • Bari T.
        • Gehrchen M.
        • Street J.
        • Dahl B.
        Morbidity and mortality of complex spine surgery: a prospective cohort study in 679 patients validating the Spine AdVerse Event Severity (SAVES) system in a European population.
        Spine J. 2016; 16: 146-153
        • Lee M.J.
        • Mohamed K.M.S.
        • Kelly J.C.
        • Galbraith J.G.
        • Street J.
        • Lenehan B.J.
        Recording adverse events following joint arthroplasty: financial implications and validation of an adverse event assessment form.
        J Arthropl. 2017; 32: 2648-2654
      3. Hospital T.U. About us - Tallaght Hospital 2022 [Available from:,with%20a%20deficit%20of%20beds.

        • Best W.R.
        • Khuri S.F.
        • Phelan M.
        • Hur K.
        • Henderson W.G.
        • Demakis J.G.
        • et al.
        Identifying patient preoperative risk factors and postoperative adverse events in administrative databases: results from the Department of Veterans Affairs National Surgical Quality Improvement Program.
        J Am Coll Surg. 2002; 194: 257-266
        • Krizek T.J.
        Surgical error: ethical issues of adverse events.
        Arch Surg. 2000; 135: 1359-1366
        • Rodriguez-Vera F.J.
        • Marin Y.
        • Sanchez A.
        • Borrachero C.
        • Pujol E.
        Illegible handwriting in medical records.
        J R Soc Med. 2002; 95: 545-546
        • Hanisch E.
        • Weigel T.
        • Buia A.
        • Bruch H.
        The validity of routine data on quality assurance: a qualitative systematic review. Der Chirurg.
        Zeitschrift fur Alle Gebiete der Operativen Medizen. 2016; 87: 56-61