Frequency of hospital-acquired pneumonia in electronic and paper-based patient record

Aim of the study was to check the validity of the electronic patient record for hospital-acquired pneumonia and to estimate its reliability. Reviewing 23,356 inpatients with admission from the 1st April 2005 and discharge up to the 30th September 2005 we identified 211 cases with hospital-acquired pneumonia in the electronic patient record whereof 70 cases taken at random were included in the validation. A second random sample of 130 cases under risk was used to calculate its completeness. For hospital-acquired pneumonia, the latest version of the definition of the Centers for Disease Control and Prevention (CDC) was applied. In 64.3% of the cases hospital-acquired pneumonia was confirmed in the paper-based patient record (45 cases, 95%-confidence interval 51.9%-75.4%). Beside 10 cases with pneumonia already existing with admission 15 cases remain where even pneumonia could not be confirmed in the paper-based patient record. Completeness was calculated as 42.9%. Estimation for the University Clinics Essen revealed a true rate of hospital-acquired pneumonia of 1.32% (308 of 23,356). The estimated true rate was higher than the measured rate of 0.90% (211 of 23,356) which is covered, nevertheless, from the 95%-confidence interval. Data from the electronic patient record seem to be sufficient to forecast the true rate of hospital-acquired pneumonia, for example, for questions of infectious disease epidemiology. However, it is not sufficient enough for special claims of the supervision, clinical hygiene and prevention for which an optimization of the data quality is required.