PMID- 23334632
OWN - NLM
STAT- MEDLINE
DCOM- 20140707
LR  - 20220330
IS  - 1549-8425 (Electronic)
IS  - 1549-8417 (Linking)
VI  - 9
IP  - 2
DP  - 2013 Jun
TI  - Description and evaluation of adaptations to the global trigger tool to enhance 
      value to adverse event reduction efforts.
PG  - 87-95
LID - 10.1097/PTS.0b013e31827cdc3b [doi]
AB  - OBJECTIVE: To adapt the Global Trigger Tool (GTT) as a sustainable monitoring 
      tool able to characterize adverse events (AEs) for organizational learning, 
      within the context of limited resources. METHODS: Baylor Health Care System 
      (BHCS) expanded the AE data collected to include judgments of preventability, 
      presence on admission, relation to care provided or not provided, and narrative 
      descriptions. To reduce costs, we focused on patients with length of stay (LOS) 
      of 3 days or more, suspecting greater likelihood they had experienced an AE; 
      adapted the sample size and frequency of review; and used a single nurse reviewer 
      followed by quality assurance review within the Office of Patient Safety. We 
      compared AE rates in patients with LOS of less than 3 days versus 3 days or 
      greater, assessed trigger yields and interrater reliability, and submitted 
      identified AEs to each hospital for validation as event types targeted for 
      reduction. RESULTS: In 2008, 91% of identified AEs were in patients with LOS of 3 
      days or greater; there were 6.4 AEs per 100 discharges with LOS of less than 3 
      days versus 27.1 AEs per 100 discharges with LOS of 3 days or greater. Over 4 
      years, we reviewed 16,172 medical records; 14,184 had positive triggers, 17.1% of 
      which were associated with an AE. Most AEs were identified via the "surgical" 
      (36.3%) and "patient care" (36.0%) trigger modules. Reviewers showed fair to good 
      agreement (kappa = 0.62), and hospital clinical leaders strongly agreed that the 
      identified events were AEs. CONCLUSIONS: The GTT can be adapted to health-care 
      organizations' goals and resource limitations. This flexibility was essential in 
      crossing our organization's "value threshold."
FAU - Kennerly, Donald A
AU  - Kennerly DA
AD  - Office of Patient Safety, Baylor Health Care System, Dallas, Texas 75206, USA. 
      Donald.kennerly@baylorhealth.edu
FAU - Saldana, Margaret
AU  - Saldana M
FAU - Kudyakov, Rustam
AU  - Kudyakov R
FAU - da Graca, Briget
AU  - da Graca B
FAU - Nicewander, David
AU  - Nicewander D
FAU - Compton, Jan
AU  - Compton J
LA  - eng
PT  - Journal Article
PT  - Validation Study
PL  - United States
TA  - J Patient Saf
JT  - Journal of patient safety
JID - 101233393
SB  - IM
MH  - *Adverse Drug Reaction Reporting Systems/standards
MH  - Data Mining
MH  - Drug-Related Side Effects and Adverse Reactions/*prevention & control
MH  - Electronic Health Records
MH  - Hospital Information Systems
MH  - Humans
MH  - Length of Stay
MH  - Medical Errors/*prevention & control
MH  - Observer Variation
MH  - Patient Discharge
MH  - *Patient Safety/standards
MH  - Prognosis
MH  - Quality Improvement
MH  - Reproducibility of Results
MH  - Texas
MH  - Time Factors
EDAT- 2013/01/22 06:00
MHDA- 2014/07/08 06:00
CRDT- 2013/01/22 06:00
PHST- 2013/01/22 06:00 [entrez]
PHST- 2013/01/22 06:00 [pubmed]
PHST- 2014/07/08 06:00 [medline]
AID - 10.1097/PTS.0b013e31827cdc3b [doi]
PST - ppublish
SO  - J Patient Saf. 2013 Jun;9(2):87-95. doi: 10.1097/PTS.0b013e31827cdc3b.