Adverse Events Detection Through Global Trigger Tool Methodology: Results From a 5-Year Study in an Italian Hospital and Opportunities to Improve Interrater Reliability

Abstract

Objective: Global Trigger Tool (GTT) has been proposed as a low-cost method to detect adverse events (AEs). The validity of the methodology has been questioned because of moderate interrater agreement. Continuous training has been suggested as a means to improve consistency over time. We present the main findings of the implementation of the Italian version of the GTT and evaluate efforts to improve the interrater reliability over time. Methods:The Italian version of the GTT was developed and implemented at the San Bonifacio Hospital, a 270-bed secondary care acute hospital in Verona, Italy. Ten clinical records randomly selected every 2 weeks were reviewed from 2009 to 2014. Two-stage interrater reliability assessment between team members was conducted on 2 subsamples of 50 clinical records before and after the implementation of specific review rules and staff training.Results: Among 1320 medical records reviewed, a total of 366 AEs were found with at least 1 AE on 20.2% of all discharges, 27.7 AEs/100 admissions, and 30.6 AEs/1000 patient-days. Adverse events with harm score E and F were respectively 58.2% (n = 213) and 38.8% (n = 142). First round interrater reliability was comparable with other international studies. The interrater agreement improved significantly after intervention (κ interrater I = 0.52, κ interrater II = 0.80, P < 0.001).Conclusions: Despite the improvements in the interrater consistency, overall results did not show any significant trend in AEs over time. Future studies may be directed to apply and adapt the GTT methodology to more specific settings to explore how to improve its sensitivity.

Describing adverse events in medical inpatients using the Global Trigger Tool

“…In this study, those determined for individual triggers ranged from 0% to 100%. Similar results were reported by one US [29] and one Italian study [30]. Studies have shown considerable variation regarding triggers' PPVs regardless of their settings or patient populations [3].…”

Adverse event detection by medical record review is reproducible, but the assessment of their preventability is not

“…The same phenomenon is also seen in other studies in which both hospital survivors and deceased patients were included. [23–30] Although our system is different in some crucial parts, the judgement concerning the preventability of AEs is comparable with the results in these studies.…”

“…In our search for better, more reliable methods we hypothesized that our method would show better outcomes compared to previous studies because in our centre the entire review committee discusses the results of the medical record evaluation instead of in pairs or by oneself as is usually reported. [4, 30–32]…”

Adverse events in women giving birth in a labor ward: a retrospective record review study

“…In obstetric care, the incidence was 5.9%, and in the labor and delivery room, the incidence was 3.7% [ 10 ]. Obstetric care has been included in studies of in-hospital adverse events [ 11 ], but sometimes these results examine obstetric care in combination with either gynecology [ 12 , 13 ] or surgery [ 14 , 15 ]; thus, rates of obstetric adverse events are difficult to pinpoint. Studies in obstetric care alone show that adverse event rates vary from 0.4–3.6%, with a preventability incidence of up to 56.3% [ 16 – 19 ].…”