PMID- 25749028
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20190131
IS  - 2044-5423 (Electronic)
IS  - 2044-5415 (Print)
IS  - 2044-5415 (Linking)
VI  - 24
IP  - 4
DP  - 2015 Apr
TI  - Application of a trigger tool in near real time to inform quality improvement 
      activities: a prospective study in a general medicine ward.
PG  - 272-81
LID - 10.1136/bmjqs-2014-003432 [doi]
AB  - BACKGROUND: Retrospective record review using trigger tools remains the most 
      widely used method for measuring adverse events (AEs) to identify targets for 
      improvement and measure temporal trends. However, medical records often contain 
      limited information about factors contributing to AEs. We implemented an 
      augmented trigger tool that supplemented record review with debriefing front-line 
      staff to obtain details not included in the medical record. We hypothesised that 
      this would foster the identification of factors contributing to AEs that could 
      inform improvement initiatives. METHOD: A trained observer prospectively 
      identified events in consecutive patients admitted to a general medical ward in a 
      tertiary care academic medical centre (November 2010 to February 2011 inclusive), 
      gathering information from record review and debriefing front-line staff in near 
      real time. An interprofessional team reviewed events to identify preventable and 
      potential AEs and characterised contributing factors using a previously published 
      taxonomy. RESULTS: Among 141 patients, 14 (10%; 95% CI 5% to 15%) experienced at 
      least one preventable AE; 32 patients (23%; 95% CI 16% to 30%) experienced at 
      least one potential AE. The most common contributing factors included policy and 
      procedural problems (eg, routine protocol violations, conflicting policies; 37%), 
      communication and teamwork problems (34%), and medication process problems (23%). 
      However, these broad categories each included distinct subcategories that seemed 
      to require different interventions. For instance, the 32 identified communication 
      and teamwork problems comprised 7 distinct subcategories (eg, ineffective 
      intraprofessional handovers, poor interprofessional communication, lacking a 
      shared patient care, paging problems). Thus, even the major categories of 
      contributing factors consisted of subcategories that individually related to a 
      much smaller subset of AEs. CONCLUSIONS: Prospective application of an augmented 
      trigger tool identified a wide range of factors contributing to AEs. However, the 
      majority of contributing factors accounted for a small number of AEs, and more 
      general categories were too heterogeneous to inform specific interventions. 
      Successfully using trigger tools to stimulate quality improvement activities may 
      require development of a framework that better classifies events that share 
      contributing factors amenable to the same intervention.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not 
      already granted under a licence) please go to 
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Wong, Brian M
AU  - Wong BM
AD  - Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 
      Toronto, Canada.
FAU - Dyal, Sonia
AU  - Dyal S
AD  - Veterans and Community Program, Sunnybrook Health Sciences Centre, University of 
      Toronto, Toronto, Canada.
FAU - Etchells, Edward E
AU  - Etchells EE
AD  - Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 
      Toronto, Canada.
FAU - Knowles, Sandra
AU  - Knowles S
AD  - Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada.
FAU - Gerard, Lauren
AU  - Gerard L
AD  - Department of Medicine, University of Toronto, Toronto, Canada.
FAU - Diamantouros, Artemis
AU  - Diamantouros A
AD  - Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Canada.
FAU - Mehta, Rajin
AU  - Mehta R
AD  - Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 
      Toronto, Canada.
FAU - Liu, Barbara
AU  - Liu B
AD  - Regional Geriatric Program, Sunnybrook Health Sciences Centre, Toronto, Canada.
FAU - Baker, G Ross
AU  - Baker GR
AD  - Institute of Health Policy, Management and Evaluation, University of Toronto, 
      Toronto, Canada.
FAU - Shojania, Kaveh G
AU  - Shojania KG
AD  - Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 
      Toronto, Canada.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150306
PL  - England
TA  - BMJ Qual Saf
JT  - BMJ quality & safety
JID - 101546984
CIN - BMJ Qual Saf. 2015 Apr;24(4):244-5. PMID: 25788292
MH  - Academic Medical Centers
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Hospitals
MH  - Humans
MH  - Male
MH  - Medical Records
MH  - Middle Aged
MH  - Near Miss, Healthcare/*statistics & numerical data
MH  - Ontario
MH  - *Patient Safety
MH  - Patients' Rooms
MH  - Prospective Studies
MH  - *Quality Improvement
MH  - Safety Management/*methods
PMC - PMC4387453
OTO - NOTNLM
OT  - Adverse events, epidemiology and detection
OT  - Hospital medicine
OT  - Trigger tools
EDAT- 2015/03/10 06:00
MHDA- 2016/12/15 06:00
PMCR- 2015/04/07
CRDT- 2015/03/10 06:00
PHST- 2015/03/10 06:00 [entrez]
PHST- 2015/03/10 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
PHST- 2015/04/07 00:00 [pmc-release]
AID - bmjqs-2014-003432 [pii]
AID - 10.1136/bmjqs-2014-003432 [doi]
PST - ppublish
SO  - BMJ Qual Saf. 2015 Apr;24(4):272-81. doi: 10.1136/bmjqs-2014-003432. Epub 2015 
      Mar 6.