The Accuracy of Trigger Tools to Detect Preventable Adverse Events in Primary Care: A Systematic Review

Davis, Joshua; Harrington, Nicole; Fagan, Heather Bittner; Henry, Barbara J.; Savoy, Margot

doi:10.3122/jabfm.2018.01.170247

Cited by 13 publications

(27 citation statements)

References 22 publications

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“…This review is different from systematic reviews previously conducted in this area, as it focuses on the value of PRR specifically for the proactive assessment of PSIs. Others have provided an overview of commonly used patient safety measurement tools [ 12 ], applied specific PRR methods such as trigger tools [ 18 ], or measured the validity and reliability of PRR [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Potential value of patient record review to assess and improve patient safety in general practice: A systematic review

Madden

Lydon

Curran

et al. 2018

European Journal of General Practice

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Background: There is limited research, and guidance, on how to address safety in general practice proactively.Objectives: This review aimed to synthesize the literature describing the use of patient record review (PRR) to measure and improve patient safety in primary care. The PRR methodologies utilized and the resulting outcomes were examined.Methods: Searches were conducted using Medline, Embase, CINAHL and PsycINFO in February 2017. Reference lists of included studies and existing review papers were also screened. English language, peer-reviewed studies that utilized PRR to identify patient safety incidents (PSIs) occurring in general practice were included. Two researchers independently extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs.Results: A total of 3265 studies were screened, with 15 included. Trigger tools were the most frequent method used for the PRRs (n = 6). The mean number of safety incidents per 100 records was 12.6. Within studies, a mean of 30.6% of incidents were associated with severe harm (range 8.6–50%), and a mean of 55.6% of incidents was considered preventable (range 32.7–93.5%). The most commonly identified types of PSIs related to medication and prescribing, diagnosis, communication and treatment. Three studies reported on improvement actions taken after the PRRs.Conclusion: This review suggests that PRR may be a promising means of proactively identifying patient safety incidents and informing improvements.

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Section: Introductionmentioning

confidence: 99%

Potential value of patient record review to assess and improve patient safety in general practice: A systematic review

Madden

Lydon

Curran

et al. 2018

European Journal of General Practice

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“…The most commonly reported method of measuring past harm was through patient record review. Papers using patient record review methodologies were included in seven reviews [ 15–31 ], with three reviews specifically focused on studies using patient record review methodologies [ 17 , 20 , 21 ]. Issues identified with the use of patient record review methodology were the potential for false positives, lack of tools and poor quality of studies [ 17 , 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…Papers using patient record review methodologies were included in seven reviews [ 15–31 ], with three reviews specifically focused on studies using patient record review methodologies [ 17 , 20 , 21 ]. Issues identified with the use of patient record review methodology were the potential for false positives, lack of tools and poor quality of studies [ 17 , 20 ]. It was suggested that a trigger tool approach to record review may offer a reliable approach to reviewing patient records [ 17 , 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…Issues identified with the use of patient record review methodology were the potential for false positives, lack of tools and poor quality of studies [ 17 , 20 ]. It was suggested that a trigger tool approach to record review may offer a reliable approach to reviewing patient records [ 17 , 20 ]. However, there is a need to refine and standardize the methods used to improve consistency and validity and facilitate ease of comparison across studies [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

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A meta-review of methods of measuring and monitoring safety in primary care

O’Connor

Madden

O’Dowd

et al. 2021

International Journal for Quality in Health Care

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Background A major barrier to safety improvement in primary care is a lack of safety data. The aims of this unfunded systematic meta-review (registration: CRD42021224367) were to: identify systematic reviews of studies that examine methods of measuring and monitoring safety in primary care; classify the methods of measuring and monitoring safety in the included systematic reviews using the five safety domains in Vincent et al.’s framework; and use this information to make recommendations for improving the measurement and monitoring of safety in primary care. Methods Four databases (Medline, Academic Search Complete, Web of Science and CINAHL), and the grey literature were screened in November 2020 and November 2020, and searches were re-run in January 2021, with searches updated in January 2021. Systematic reviews were included if they: addressed measures of patient safety in primary care; and were published in English. Studies were assessed using the Critical Appraisal Skills Programme for systematic reviews. Results A total of 6,904 papers were screened, with 13 systematic reviews included. A commonly reported method of measuring past harm was through patient record review. The most frequent methods for assessing the reliability of safety critical processes were checklists, observations, and surveys of staff. Methods used to assess sensitivity to operations included observation, staff surveys, interviews, focus groups, active monitoring, and simulated patients. Safety climate surveys were a commonly used as an approach to assess anticipation and preparedness. A number of the reviews concluded that safety data could, and should, be used for integration and learning. The main limitation of the meta-review was that it was of systematic reviews only. Conclusions Many of the methods for measuring and monitoring safety are readily available, quick to administer, do not require external involvement, and are inexpensive. However, there is still a need to improve the psychometric properties of many methods. Researchers must support the development of psychometrically sound safety measures that do not over burden primary care practitioners. Policy makers must consider how primary care practitioners can be supported to implement these measures.

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“…A 'negative' study in this issue is the article by Davis et al 13 on the Institute for Health care Improvement's (IHI) Outpatient Adverse Event Trigger Tool (IHI Tool). After searching more than 6,000 articles, 15 met eligibility criteria, 9 of which were conducted in the United States, 12 were retrospective, most were done at 1 site only, and only 4 were rated as "good" quality.…”

Section: Not Realisticmentioning

confidence: 99%

Interventions Must Be Realistic to Be Useful and Completed in Family Medicine

Bowman¹,

Seehusen

Neale³

2018

J Am Board Fam Med

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Being realistic while helping our patients is this issue's theme. Given the volume of tasks required in family medicine, recommendations for improvements in direct care or care measurement cannot just be evidence-based but must also be realistic. On the list of realistic: ordering antipsychotics for symptoms of dementia in the elderly, despite recommendations to not do so; ordering antidepressants without fear that the patient could develop hypertension; mental health care providers in primary care offices; forced choice for opioid management; plus agenda setting for visit efficiency. In this issue we group articles into general categories based on our assessment of how realistic the implied actions are, related to current provider training, finances, and organizational factors.

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The Accuracy of Trigger Tools to Detect Preventable Adverse Events in Primary Care: A Systematic Review

Cited by 13 publications

References 22 publications

Potential value of patient record review to assess and improve patient safety in general practice: A systematic review

Potential value of patient record review to assess and improve patient safety in general practice: A systematic review

A meta-review of methods of measuring and monitoring safety in primary care

Interventions Must Be Realistic to Be Useful and Completed in Family Medicine

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