A scoping review of the methodological approaches used in retrospective chart reviews to validate adverse event rates in administrative data

Background Patient safety is a key quality issue for health systems. Healthcare acquired adverse events (AEs) compromise safety and quality; therefore, their reporting and monitoring is a patient safety priority. Although administrative datasets are potentially efficient tools for monitoring rates of adverse events, concerns remain over the accuracy of their data. Chart review validation studies are required to explore the potential of administrative data to inform research and health policy. This review aims to present an overview of the methodological approaches and strategies used to validate rates of adverse events in administrative data through chart review. Methodology This review was conducted in line with the Joanna Briggs Institute methodological framework for scoping reviews. Through database searches, 1054 sources were identified, imported into Covidence, and screened against the inclusion criteria. Articles that validated rates of AEs in administrative data through chart review were included. Data were extracted, exported to Microsoft Excel, arranged into a charting table, and presented in a tabular and descriptive format. Results Fifty-six studies were included. Most sources reported on surgical adverse events however, other medical specialties were also explored. Chart reviews were used in all studies, however few agreed on terminology for the study design. Various methodological approaches and sampling strategies were used. Some studies used the Global Trigger Tool, a two-stage chart review method, whilst others used alternative single-, two-stage or unclear approaches. The sources used samples of flagged charts (n=24), flagged and random charts (n=11) and random charts (n=21). Most studies reported poor or moderate accuracy of adverse event rates. Some studies reported good accuracy of adverse event recording which highlights the potential of using administrative data for research purposes. Conclusions This review highlights the potential for administrative data to provide information on adverse event rates and improve patient safety and healthcare quality. Nonetheless, further work is warranted to ensure that administrative data are accurate. The variation of methodological approaches taken, and sampling techniques used demonstrate a lack of consensus on best practice, therefore, further clarity and consensus are necessary to develop a more systematic approach to chart reviewing.