Comparison of traditional trigger tool to data warehouse based screening for identifying hospital adverse events

O’Leary, Kevin J.; Devisetty, Vikram K; Patel, Ashlesha; Malkenson, David; Sama, Pradeep; Thompson, William K.; Landler, Matthew P.; Barnard, Cynthia; Williams, Mark

doi:10.1136/bmjqs-2012-001102

Cited by 40 publications

(62 citation statements)

References 29 publications

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“…“Abrupt medication stop” was a criterion in five studies; one [23] specified this for an enterprise data warehouse query as “discontinuation of 4 of more medications in a 6 h period >48 h after admission and at least 24 h prior to discharge”.…”

Section: Resultsmentioning

confidence: 99%

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Clinical criteria to screen for inpatient diagnostic errors: a scoping review

Shenvi

El‐Kareh

2014

Diagnosis

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Diagnostic errors are common and costly, but difficult to detect. “Trigger” tools have promise to facilitate detection, but have not been applied specifically for inpatient diagnostic error. We performed a scoping review to collate all individual “trigger” criteria that have been developed or validated that may indicate that an inpatient diagnostic error has occurred. We searched three databases and screened 8568 titles and abstracts to ultimately include 33 articles. We also developed a conceptual framework of diagnostic error outcomes using real clinical scenarios, and used it to categorize the extracted criteria. Of the multiple criteria we found related to inpatient diagnostic error and amenable to automated detection, the most common were death, transfer to a higher level of care, arrest or “code”, and prolonged length of hospital stay. Several others, such as abrupt stoppage of multiple medications or change in procedure, may also be useful. Validation for general adverse event detection was done in 15 studies, but only one performed validation for diagnostic error specifically. Automated detection was used in only two studies. These criteria may be useful for developing diagnostic error detection tools.

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Section: Resultsmentioning

confidence: 99%

“…Only two studies used automated methods: one compared automated with traditional manual triggers [23] and another electronically screened discharge summary text [41]. These did not report proportion of errors that were diagnostic in nature.…”

Section: Resultsmentioning

confidence: 99%

Clinical criteria to screen for inpatient diagnostic errors: a scoping review

Shenvi

El‐Kareh

2014

Diagnosis

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“…Including an economic dimension to the knowledge gained from research into quality and safety is an important part of the health system reform that is being implemented in Portugal [5,12,29,30]. Moreover, it could be a starting point for specific interventions in the improvement of patient safety and it may help to prioritise research areas for the near future [6,20,27,31]. …”

Section: Discussionmentioning

confidence: 99%

“…We observed that the quality of patient records could be better, although this did not significantly limit the study. Retrospective patient record studies still represent the “gold-standard” method for assessing incidence and monitoring the frequency of AEs [13,20,31,32] and the use of similar methods to those used elsewhere allows comparisons to be made. However, for a more comprehensive assessment of safety, other methods also need to be used, including reporting and learning systems, root-cause analyses, failure mode effects analyzes and morbidity and mortality reviews [13,33].…”

Section: Discussionmentioning

confidence: 99%

Estimating the incidence of adverse events in Portuguese hospitals: a contribution to improving quality and patient safety

Sousa

Uva

Serranheira

et al. 2014

BMC Health Serv Res

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BackgroundSeveral review studies have shown that 3.4% to 16.6% of patients in acute care hospitals experience one or more adverse events. Adverse events (AEs) in hospitals constitute a significant problem with serious consequences and a challenge for public health. The occurrence of AEs in Portuguese hospitals has not yet been systematically studied. The main purpose of this study is to estimate the incidence, impact and preventability of adverse events in Portuguese hospitals. It is also our aim to examine the feasibility of applying to Portuguese acute hospitals the methodology of detecting AEs through record review, previously used in other countries.MethodsThis work is based on a retrospective cohort study and was carried out at three acute care hospitals in the Administrative Region of Lisbon. The identification of AEs and their impact was done using a two-stage structured retrospective medical records review based on the use of 18 screening criteria. A random sample of 1,669 medical records (representative of 47,783 hospital admissions) for the year 2009 was analyzed.ResultsThe main results found in this study were an incidence rate of 11.1% AEs, of which around 53.2% were considered preventable. The majority of AEs were associated with surgical procedures (27%), drug errors (18.3%) and hospital acquired infections (12.2%). Most AEs (61%) resulted in minimal or no physical impairment or disability, and 10.8% were associated with death. In 58.6% of the AEs’ cases, the length of stay was prolonged on average 10.7 days. Additional direct costs amounted to €470,380.00.ConclusionThe magnitude of these results was critical, reinforcing the need of more detailed studies in this area. The knowledge of the incidence and nature of AEs that occur in hospitals should be seen as a first step towards the improvement of quality and safety in health care.

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“…We used a modified version of the classic 2-stage method to identify and confirm AEs. 2 In the first stage, we used computerized screens, based on criteria from the Harvard Medical Practice Study and Institute for Healthcare Improvement global trigger tool, to identify potential AEs. [3][4][5] A research nurse created narrative summaries of potential AEs.…”

mentioning

confidence: 99%