Characterization of Adverse Events Detected in a Large Health Care Delivery System Using an Enhanced Global Trigger Tool over a Five‐Year Interval

Kennerly, Donald A.; Kudyakov, Rustam; Graca, Briget da; Saldaña, Margaret; Compton, Jan; Nicewander, David; Gilder, Richard E.

doi:10.1111/1475-6773.12163

Cited by 55 publications

(78 citation statements)

References 19 publications

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“…Our results are consistent with other studies indicating that admission to a surgical department and having surgery increases the rate of AEs [16,23]. A majority of our cancer patients are admitted to surgical departments and 36% have surgery.…”

Section: Discussionsupporting

confidence: 92%

Adverse events in hospitalised cancer patients: a comparison to a general hospital population

et al. 2017

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Background: Patients with cancer are often treated by many healthcare providers, receive complex and potentially toxic treatments that can increase the risk for iatrogenic harm. The aim of this study is to investigate whether hospitalised cancer patients are at higher risk of adverse events (AEs) compared to a general hospital population. Material and methods: A total of 6720 patient records were retrospectively reviewed comparing AEs in hospitalised cancer patients to a general hospital population in Norway, using the IHI Global Trigger Tool method. Results: 24.2 percent of admissions for cancer patients had an AE compared to 17.4% of admissions of other patients (p < .001, rr 1.39, 95% CI 1.19-1.62). However, cancer patients did not have a higher rate of AEs per 1000 patient days compared to other patients, 37.1 vs. 36.0 (p ¼ .65, rr 0.94, 95% CI 0.90-1.18). No particular cancer category is at higher risk. The rate of AEs increases by 1.05 times for each day spent in hospital. For every year increase in age, the risk for AEs increases by 1.3%. Cancer patients more often have hospital-acquired infections, other surgical complications and AEs related to medications. Conclusions: Because of higher age, longer length of stay and surgical treatment, hospitalised cancer patients experience AEs more often than other patients.

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Section: Discussionsupporting

confidence: 92%

Adverse events in hospitalised cancer patients: a comparison to a general hospital population

et al. 2017

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“…The harm rate of 9% in Wales using the GTT is considerably lower than any of the US-based studies examining harm in secondary care settings 4,21,41,75 and it is very unlikely that this reflects a true difference in AE rates between the US and UK health systems. Some GTT studies do not exclude AEs present on admission and it remains unclear what the GTT is actually measuring.…”

Section: The Comparison Of the Global Trigger Tool And Two-stage Retrmentioning

confidence: 86%

“…[17][18][19][20][21] Although progress on measurement and evaluation is being made within the emerging international agenda of improvement science, challenges remain. Despite comprehensive work undertaken to develop an international classification for patient safety, 22 there is still evidence that key concepts and terms are not consistent across research studies and improvement efforts.…”

Section: The Measurement Of Harmmentioning

confidence: 99%

“…19 Even higher rates of detection of AEs using the GTT methodology have been confirmed in other studies, for which AE rates in hospitalised patients are consistently reported to be > 30% of all inpatient admissions. 4,21,[41][42][43] Naessens et al 41 assessed the ability of nurse reviewers, using GTT methodology, to detect AEs in four US hospitals and reported favourable levels of detection of both triggers (κ = 0.63, 95% CI 0.58 to 0.68) and AEs (κ = 0.51, 95% CI 0.45 to 0.57). In a study evaluating the reliability of the GTT in tracking local and national AE rates, agreement by nurse reviewers was reported to be within a range of κ = 0.40-0.60.…”

Section: The Measurement Of Harm In Inpatient Settings: An Overviewmentioning

confidence: 99%

“…Some GTT studies do not exclude AEs present on admission and it remains unclear what the GTT is actually measuring. Although the GTT undoubtedly identifies significant problems in processes and clinical care in order to prioritise improvement efforts, 21,75 it may also detect signal noise, which does not translate into actual AEs. This may be compounded by the limited time to examine the notes, which prevents contextualising these triggers and subsequent overestimation of harm rates.…”

Section: The Comparison Of the Global Trigger Tool And Two-stage Retrmentioning

confidence: 99%

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Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Mayor

Baines

Vincent

et al. 2017

Health Serv Deliv Res

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Background, objectives and settingDespite global activity over the past 15 years to improve patient safety, the measurement of adverse events (AEs) remains challenging.ObjectivesWe aimed to obtain definitive longitudinal data on harm across NHS Wales and to compare the performance of the Global Trigger Tool (GTT) with the two-stage retrospective review process, using our findings to consolidate an approach to the ongoing surveillance of harm in Wales.Data sourcesEleven of the 13 major Welsh NHS hospitals.Review methodsThe two-stage retrospective review methodology was used to quantify harm across NHS Wales. In total, 4536 inpatient episodes were screened for AEs by research nurses. Records that were highly suggestive of AEs were further assessed by physicians. NHS-led teams undertook GTT reviews on the same case notes.ResultsAt least one AE was determined in 10.3% of episodes of care [95% confidence interval (CI) 9.4% to 11.2%] and 51.5% were preventable (95% CI 46.9% to 56.1%). The percentage of patients identified with AEs using the GTT methodology was lower, at 9.0% (95% CI 8.82% to 9.18%). Differences in AEs were evident across study sites. Methods were developed to profile the risk of AEs in individual organisations by producing signatures of harm for each NHS site. Analysis indicated that neither the GTT nor the two-stage process was a candidate tool for routine surveillance, and a hybrid one-stage tool (Harm2), based on phase 1 findings, was developed for ongoing AE monitoring. Using the Harm2 tool, AEs were identified in 371 out of 3352 randomly selected discharge reviews (11.3%, 95% CI 10.2% to 12.4%), and 59.6% (95% CI 55.3 to 63.9) of these were preventable. In a cohort of randomly selected deceased patient reviews, at least one AE was determined in 315 out of 1018 admissions (30.1%, 95% CI 28.1% to 33.8%), and 61.7% (95% CI 57.5% to 65.9%) of these were preventable. Factors associated with AEs in the randomly selected discharge reviews included having peripheral vascular disease [odds ratio (OR) 2.52], hemiplegia (OR 2.27) or dementia (OR 2.27). No association with chronic disease was identified in the deceased episodes of care.LimitationsThe dependence on our health service partners in identifying notes to be reviewed, along with the small sample examined each month, limits the generalisability of these findings and rates were not standardised for hospital and size and level of services provided. We cannot rule out the possibility that the rates we report may be underestimated.ConclusionThe extent of harm detected across NHS Wales using both the two-stage retrospective review process and the new Harm2 tool conforms to the findings in the literature, but this is the first longitudinal study using these methods. With training and using a structured review process, non-physician reviewers can undertake case note review efficiently and effectively, and the rates of AEs and of the preventability and the breakdown of problems in care conform to those reported in studies in which physicians undertake these classifications. Whether the patient died or was discharged alive significantly influences the rate and composition of AEs. The Harm2 tool performed with moderate reliability in the determination of AEs.Future workFuture large-scale studies should attempt to specify types of AEs, such as hospital-acquired infections and surgical complications, to enable the surveillance of the specific types of harm as well as the overall level of AEs. In the longer term, we need to automate harm surveillance and set measures of harm alongside measures of the beneficial effects of health care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Errors in Veterinary Anesthesia

Ludders¹,

McMillan²

2016

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Characterization of Adverse Events Detected in a Large Health Care Delivery System Using an Enhanced Global Trigger Tool over a Five‐Year Interval

Abstract: AEs are common and potentially amenable to prevention. GTT-identified AEs are seldom caught by commonly used AE-detection systems.

Cited by 55 publications

References 19 publications

Adverse events in hospitalised cancer patients: a comparison to a general hospital population

Adverse events in hospitalised cancer patients: a comparison to a general hospital population

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Errors in Veterinary Anesthesia

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