Is a modified Global Trigger Tool method using automatic trigger identification valid when measuring adverse events?

Abstract

Objectives To evaluate a modified Global Trigger Tool (GTT) method with manual review of automatic triggered records to measure adverse events. Design A cross-sectional study was performed using the original GTT method as gold standard compared to a modified GTT method. Setting Medium size hospital trust in Northern Norway. Participants One thousand two hundred thirty-three records selected between March and December 2013. Main outcome measure Records with triggers, adverse events and number of adverse events identified. Recall (sensitivity), precision (positive predictive value), specificity and Cohen’s kappa with 95 % confidence interval were calculated. Results Both methods identified 35 adverse events per 1000 patient days. The modified GTT method with manual review of 658 automatic triggered records identified adverse events (n = 214) in 189 records and the original GTT method identified adverse events (n = 216) in 186 records. One hundred and ten identical records were identified with adverse events by both methods. Recall, precision, specificity and reliability for records identified with adverse events were respectively 0.59, 0.58, 0.92 and 0.51 for the modified GTT method. The total manual review time in the modified GTT method was 23 h while the manual review time using the original GTT method was 411 h. Conclusions The modified GTT method is as good as the original GTT method that complies with the GTTs aim monitoring the rate of adverse events. Resources saved by using the modified GTT method enable for increasing the sample size. The automatic trigger identification system may be developed to assess triggers in real-time to mitigate risk of adverse events.

<p>Translation, Cross-Cultural Adaptation, and Measurement Properties of the Portuguese Version of the Global Trigger Tool for Adverse Events</p>

“…The GTT-PT identified an AE prevalence of 36%, similarly to the values reported by Brösterhaus 29 (32.5%), Mevik 17 (34.7%), and Parrinello 26 (30.4%). However, Toscano 24 and Karpov 27 reported much lower values (24.7% and 13.2%, respectively).…”

“…It should be noted that the main objective of GTT is to identify and classify the patient harm and not to determine the possibility of avoiding it. 17 , 18 , 22…”

“…It should be noted that the main objective of GTT is to identify and classify the patient harm and not to determine the possibility of avoiding it. 17,18,22 This study was based on the administration of the GTT methodology developed by the IHI. 22 The procedure was divided into two stages:…”

“…13 However, the literature shows that most incidents are not reported by health professionals, 14 with underreporting 15 since only 10-20% of the AEs are reported. [16][17][18] Likewise, the codification of clinical processes is affected by the quality of the records made by health professionals, 17,18 and thus the analysis of AEs becomes insufficient.…”

Quality improvement in healthcare: the need for valid, reliable and efficient methods and indicators

“…Mevik et al . [6] evaluated a modified GTT method with a manual review of automatically triggered records to measure AEs using the original GTT method as a gold standard. However, the modified GTT method was more reliable and efficient when it came to monitoring and accurately identifying AEs.…”