PMID- 30621689
OWN - NLM
STAT- MEDLINE
DCOM- 20190417
LR  - 20200225
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 19
IP  - 1
DP  - 2019 Jan 8
TI  - The Harvard medical practice study trigger system performance in deceased 
      patients.
PG  - 16
LID - 10.1186/s12913-018-3839-6 [doi]
LID - 16
AB  - BACKGROUND: To detect possible threats to quality and safety, multiple systems 
      have been developed. One of them is retrospective chart review. A team of experts 
      scrutinizes medical records, selected by trigger systems, to detect possible 
      adverse events (AEs). The most important AEs and more hints for possible 
      improvement of care appear in deceased patients. Using triggers in a sample of 
      these patients might increase the performance and lower the burden of 
      scrutinizing records without possible preventable AEs. The aim of this study was 
      therefore to determine the performance of the trigger system in a sample of 
      deceased patients and to calculate the specificity and the sensitivity of this 
      trigger system for predicting AEs. METHODS: We performed a study in which the 
      records of deceased patients were screened for triggers by a team of trained 
      nurses. A sample of 100 medical records was randomly selected out of records 
      which had been screened between 2012 and 2015 for the first time, prior to the 
      study in 2016. For the determination of significant differences between the first 
      and second screening, McNemar's test of symmetry was used. Also, observed 
      agreement, Cohen's Kappa and prevalence-adjusted and-bias-adjusted-kappa (PABAK) 
      statistics were calculated. This was done for the two trigger rounds on both any 
      trigger present and for every trigger separately. RESULTS: The observed agreement 
      for any given trigger was 75% with a Kappa and PABAK of 0.5. For the individual 
      triggers, the observed agreement was on average 90%. The corresponding Kappa was 
      on average 0.42 (range: - 0.03-0.78) and the average PABAK was 0.8 (range: 
      0.44-0.92). Two adverse events were found in cases without triggers previously. 
      The recalculated specificity and sensitivity for the original population were 58 
      and 92% respectively. CONCLUSIONS: For the reproducibility of triggers it seems 
      that some perform better than others, but on average this is to our opinion 
      suboptimal. The low specificity implies that many records are selected without 
      AEs. This leads to a high false-positive rate making this labour-intensive record 
      review process costly. Therefore, research for better and more expedient systems 
      is required.
FAU - Klein, Dorthe O
AU  - Klein DO
AUID- ORCID: 0000-0003-0182-9569
AD  - Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), 
      Maastricht University Medical Centre+, Maastricht, the Netherlands. 
      Dorthe.klein@mumc.nl.
FAU - Rennenberg, Roger J M W
AU  - Rennenberg RJMW
AD  - Department of Internal Medicine, Maastricht University Medical Centre+, 
      Maastricht, the Netherlands.
FAU - Koopmans, Richard P
AU  - Koopmans RP
AD  - Department of Internal Medicine, Maastricht University Medical Centre+, 
      Maastricht, the Netherlands.
FAU - Prins, Martin H
AU  - Prins MH
AD  - Department of Epidemiology, School for Public Health and Primary Care, Maastricht 
      University, Maastricht, the Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20190108
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - Clinical Audit
MH  - Data Accuracy
MH  - *Death
MH  - Drug-Related Side Effects and Adverse Reactions
MH  - Humans
MH  - Medical Errors/*statistics & numerical data
MH  - Medical Records/*statistics & numerical data
MH  - Patient Safety/*statistics & numerical data
MH  - *Precipitating Factors
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - *Software
PMC - PMC6323723
OTO - NOTNLM
OT  - Hospital
OT  - Kappa
OT  - Medical record review
OT  - PABAK
OT  - Reproducibility
OT  - Triggers
COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study protocol was approved by 
      the medical ethics committee of the Maastricht University Medical Centre. 
      Retrospective medical record review of deceased patients is not covered by the 
      WMO. On such retrospective examination, only the Medical Treatment Agreement Act 
      (WGBO) applies and, the Personal Data Protection Act (Wbp) has fallen. 
      Furthermore, it was checked whether the patient included in this study, ever made 
      objections to using their data for study purposes. If so, their data would not 
      have been included. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: 
      The authors declare that they have no competing interests. PUBLISHER'S NOTE: 
      Springer Nature remains neutral with regard to jurisdictional claims in published 
      maps and institutional affiliations.
EDAT- 2019/01/10 06:00
MHDA- 2019/04/18 06:00
PMCR- 2019/01/08
CRDT- 2019/01/10 06:00
PHST- 2017/09/22 00:00 [received]
PHST- 2018/12/18 00:00 [accepted]
PHST- 2019/01/10 06:00 [entrez]
PHST- 2019/01/10 06:00 [pubmed]
PHST- 2019/04/18 06:00 [medline]
PHST- 2019/01/08 00:00 [pmc-release]
AID - 10.1186/s12913-018-3839-6 [pii]
AID - 3839 [pii]
AID - 10.1186/s12913-018-3839-6 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2019 Jan 8;19(1):16. doi: 10.1186/s12913-018-3839-6.