PMID- 20513790
OWN - NLM
STAT- MEDLINE
DCOM- 20110204
LR  - 20101027
IS  - 1475-3901 (Electronic)
IS  - 1475-3898 (Linking)
VI  - 19
IP  - 5
DP  - 2010 Oct
TI  - Development of trigger tools for surveillance of adverse events in ambulatory 
      surgery.
PG  - 425-9
LID - 10.1136/qshc.2008.031591 [doi]
AB  - BACKGROUND: The trigger tool methodology uses clinical algorithms applied 
      electronically to 'flag' medical records where adverse events (AEs) have most 
      likely occurred. The authors sought to create surgical triggers to detect AEs in 
      the ambulatory care setting. METHODS: Four consecutive steps were used to develop 
      ambulatory surgery triggers. First, the authors conducted a comprehensive 
      literature review for surgical triggers. Second, a series of multidisciplinary 
      focus groups (physicians, nurses, pharmacists and information technology 
      specialists) provided user input on trigger selection. Third, a clinical advisory 
      panel designed an initial set of 10 triggers. Finally, a three-phase Delphi 
      process (surgical and trigger tool experts) evaluated and rated the suggested 
      triggers. RESULTS: The authors designed an initial set of 10 surgical triggers 
      including five global triggers (flagging medical records for the suspicion of any 
      AE) and five AE-specific triggers (flagging medical records for the suspicion of 
      specific AEs). Based on the Delphi rating of the trigger's utility for 
      system-level interventions, the final triggers were: (1) emergency room visit(s) 
      within 21 days from surgery; (2) unscheduled readmission within 30 days from 
      surgery; (3) unscheduled procedure (interventional radiological, urological, 
      dental, cardiac or gastroenterological) or reoperation within 30 days from 
      surgery; (4) unplanned initial hospital length of stay more than 24 h; and (5) 
      lower-extremity Doppler ultrasound order entry and ICD code for deep vein 
      thrombosis or pulmonary embolus within 30 days from surgery. CONCLUSION: The 
      authors therefore propose a systematic methodology to develop trigger tools that 
      takes into consideration previously published work, end-user preferences and 
      expert opinion.
FAU - Kaafarani, Haytham M A
AU  - Kaafarani HM
AD  - Department of Surgery, VA Boston Healthcare System, West Roxbury, Massachusetts 
      02132, USA.
FAU - Rosen, Amy K
AU  - Rosen AK
FAU - Nebeker, Jonathan R
AU  - Nebeker JR
FAU - Shimada, Stephanie
AU  - Shimada S
FAU - Mull, Hillary J
AU  - Mull HJ
FAU - Rivard, Peter E
AU  - Rivard PE
FAU - Savitz, Lucy
AU  - Savitz L
FAU - Helwig, Amy
AU  - Helwig A
FAU - Shin, Marlena H
AU  - Shin MH
FAU - Itani, Kamal M F
AU  - Itani KM
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20100531
PL  - England
TA  - Qual Saf Health Care
JT  - Quality & safety in health care
JID - 101136980
MH  - Advisory Committees
MH  - Ambulatory Surgical Procedures/*adverse effects
MH  - Delphi Technique
MH  - Focus Groups
MH  - Humans
MH  - *Medical Errors
MH  - Population Surveillance/*methods
MH  - *Quality Indicators, Health Care
MH  - Review Literature as Topic
MH  - *Surgicenters
EDAT- 2010/06/02 06:00
MHDA- 2011/02/05 06:00
CRDT- 2010/06/02 06:00
PHST- 2010/06/02 06:00 [entrez]
PHST- 2010/06/02 06:00 [pubmed]
PHST- 2011/02/05 06:00 [medline]
AID - qshc.2008.031591 [pii]
AID - 10.1136/qshc.2008.031591 [doi]
PST - ppublish
SO  - Qual Saf Health Care. 2010 Oct;19(5):425-9. doi: 10.1136/qshc.2008.031591. Epub 
      2010 May 31.