Development of a trigger tool to identify adverse events and harm in Emergency Medical Services

Howard, Ian; Bowen, James M.; Shaikh, Loua Asad Hanna Al; Mate, Kedar S.; Owen, Robert; Williams, David M.

doi:10.1136/emermed-2016-205746

Cited by 25 publications

(24 citation statements)

References 16 publications

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“…Our data indicate that a pLA less than 4 mmol/L in people with acute disease, categorized with low risk, but also for those with NEWS2 < 3, indicates a minimal risk of mortality. In contrast, a pLA greater than 4 mmol/L, despite a low risk, is associated with a significant increase in mortality, which it was also seen for patients with NEWS2 > 3, a fact that should be taken into account by professionals when predicting early SAEs, even in those a priori less serious situations [40,41].…”

Section: Discussionmentioning

confidence: 94%

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Martin-Rodríguez

López-Izquierdo

Benito³

et al. 2020

JCM

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The objective of this study was to assess whether the use of prehospital lactate (pLA) can increase the prognostic accuracy of the National Early Warning Score 2 (NEWS2) to detect the risk of death within 48 h. A prospective, multicenter study in adults treated consecutively by the emergency medical services (EMS) included six advanced life support (ALS) services and five hospitals. Patients were assigned to one of four groups according to their risk of mortality (low, low-medium, medium, and high), as determined by the NEWS2 score. For each group, the validity of pLA in our cohort was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. In this study, 3081 participants with a median age of 69 years (Interquartile range (IQR): 54–81) were included. The two-day mortality was 4.4% (137 cases). The scale derived from the implementation of the pLA improved the capacity of the NEWS2 to discriminate low risk of mortality, with an AUC of 0.910 (95% CI: 0.87–0.94; p < 0.001). The risk stratification provided by the NEWS2 can be improved by incorporating pLA measurement to more accurately predict the risk of mortality in patients with low risk.

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Section: Discussionmentioning

confidence: 94%

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Martin-Rodríguez

López-Izquierdo

Benito³

et al. 2020

JCM

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“…The EMS triggers were previously developed over several derivation rounds and a single large sample analysis for performance assessment/test characteristics [10]. As a retrospective sampling strategy for the targeted identification of cases at risk for potential AEs and harm, the EMS triggers demonstrated both a superior sensitivity and specificity compared to a random sampling strategy for audit case identification (See Table 1 for EMS Trigger Items).…”

Section: Methodsmentioning

confidence: 99%

“…The early development and testing of EMS specific triggers for the identification of AEs and Harm has been previously described [10]. The primary focus for these triggers was on the the low risk/high frequency case cohort of an EMS organisation.…”

Section: Introductionmentioning

confidence: 99%

Application of the emergency medical services trigger tool to measure adverse events in prehospital emergency care: a time series analysis

et al. 2018

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BackgroundEmergency Care has previously been identified as an area of significant concern regarding the prevalence of Adverse Events (AEs). However, the majority of this focus has been on the in-hospital setting, with little understanding of the identification and incidence of AEs in the prehospital environment.MethodThe early development and testing of Emergency Medical Services (EMS) specific triggers for the identification of AEs and Harm has been previously described. To operationalise the Emergency Medical Services Trigger Tool (EMSTT), the processes developed by the Institute for Healthcare Improvement for use with the Global Trigger Tool were adapted to a prehospital emergency care setting. These were then applied using a stepwise approach to the analysis of 36 consecutive samples of patient care records over an 18-month period (n = 710). Inter-rater reliability was measured for each trigger item and level of Harm classification. Total Triggers per 10,000 Patient Encounters, AEs per 10,000 Patient Encounters and Harm per 10,000 Patient Encounters were measured. All measures were plotted on Statistical Process Control Charts.ResultsThere was a high level of inter-rater agreement across all items (range: 85.6–100%). The EMSTT found an average rate of 8.20 Triggers per 10,000 Patient Encounters, 2.48 AEs per 10,000 Patient Encounters and 0.34 Harm events per 10,000 Patient Encounters. Three triggers: Change in Systolic Blood Pressure Greater Than 20%; Temp > 38 °C without subsequent reduction; and SpO2 < 94% without supplemental Oxygen or SpO2 < 85% without assisted ventilation accounted for 93% (n = 180) of the triggers found throughout the longitudinal analysis.DiscussionWith sufficient focus on implementation and data collection, as well as the inclusion of a contextually relevant system for classifying AE/Harm, the EMSTT represents a potentially successful strategy towards identifying the rate of AEs within EMS across a large patient population with limited commitment of time and resources.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0195-0) contains supplementary material, which is available to authorized users.

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“…Une étude monocentrique taïwanaise a montré que l'utilisation des triggers permet de détecter plus d'EI évitables que d'autres méthodes de signalement d'EI dans un SAU [19]. Une étude récente [20] a identifié un certain nombre de triggers applicables à la médecine d'urgence à l'aide de la littérature. Ils ont étudié neuf indicateurs d'EI dans deux SAU au Qatar et aux États-Unis.…”

Section: Résultatsunclassified

Détection d’événements indésirables par la méthode des trigger tools à partir des dossiers de régulation au sein d’un CRRA 15

Bechu

Payet

Bounes

2018

Ann. Fr. Med. Urgence

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Objectif : La méthode dite des trigger tools permet une analyse objective, rapide et fiable des risques portant sur l'examen de dossiers de patients ciblés afin de mettre en évidence des d'événements indésirables (EI) évitables ou porteurs de risques (EPR). L'intérêt de cette méthode n'a jamais été étudié dans le cadre d'un centre de réception et de régulation des appels 15 (CRRA 15). L'objectif était d'évaluer la pertinence de triggers choisis au sein d'un CRRA 15 afin de mettre en place un système de détection d'EI par la méthode des trigger tools. Matériel et méthodes : Au sein du SAMU 31, au CHU de Toulouse, les dossiers de régulation (DR) étaient extraits en cas de déclenchement de triggers prédéfinis : délais de départ SMUR, délais d'arrivée, temps de prise en charge sur place, délais de décision d'envoi d'une équipe SMUR après le premier appel, patients décédés et réorientations des patients dans les 48 heures. Le critère de jugement principal était le pourcentage d'EI évitables et d'EPR, parmi les patients dont le dossier a déclenché un trigger donné, c'est-à-dire la prévalence du trigger. Les critères de jugement secondaires étaient la gravité de chaque EI évitable selon l'AHRQ severity scale et les facteurs favorisant leur survenue. Résultats : Du 9 juillet 2011 au 13 avril 2012, 174 536 DR ont été traités, 4 404 (2,5 %) ont déclenché un trigger (soit 2 882 patients). On retrouvait 203 DR avec un EI, qui concernaient 153 patients ; 73 présentaient un EI évitable, 16 un EPR, 30 un EI non évitable. La prévalence de chaque trigger était de 17,6 % (IC 95 % : 4,8-20,4 %) pour celui « délai de départ », 6,7 % (IC 95 % : 3,7-9,7 %) pour le trigger « réorientation précoce », 6,4 % (IC 95 % : 4,6-8,2 %) pour celui « délai de décision SMUR », 3,4 % (IC 95 % : 0,1-7,2 %) pour le trigger « temps sur place », 2,9 % (IC 95 % : 0,1-8,5 %) pour celui « délai d'arrivée » et 3 % (IC 95 % : 1,5-4,5 %) pour le trigger « décès ». Conclusion : Les triggers qui semblaient les plus pertinents étaient donc « délai de décision SMUR », « réorientation précoce » et « décès ». La méthode des trigger tools permet une analyse rapide et efficace des DR, essentielle pour réduire le risque et améliorer la qualité de prise en charge des patients. Mots clés Qualité · Préhospitalier · Événement indésirable · Trigger toolsAbstract Aims: The "trigger tools" method is an objective risk analysis for examining targeted patient records in order to identify avoidable adverse events (AE). Our objective was to evaluate the relevance of selected triggers in a French prehospital medicalized emergency service in order to implement a routine system for the detection of adverse events. Procedure: In Toulouse University Hospital SAMU, regulatory files were automatically extracted from the patients charts based on predefined triggers: times of departure for the team, arrival time on site, assessment time, time taken by the dispatcher after the first call to send a medicalized team, deceased patients and reorientation of patients to another institution wit...

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Development of a trigger tool to identify adverse events and harm in Emergency Medical Services

Abstract: The Emergency Medical Services Trigger Tool (EMSTT) may be used as a sampling strategy similar to the Global Trigger Tool, to identify and measure AE and harm over time, and monitor the success of improvement initiatives within the Emergency Medical Services setting.

Cited by 25 publications

References 16 publications

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Application of the emergency medical services trigger tool to measure adverse events in prehospital emergency care: a time series analysis

Détection d’événements indésirables par la méthode des trigger tools à partir des dossiers de régulation au sein d’un CRRA 15

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