PMID- 33676370 OWN - NLM STAT- MEDLINE DCOM- 20210728 LR - 20210728 IS - 1464-3677 (Electronic) IS - 1353-4505 (Linking) VI - 33 IP - 1 DP - 2021 Mar 18 TI - Assessment of the reliability of the IHI Global Trigger Tool: new perspectives from a Brazilian study. LID - mzab039 [pii] LID - 10.1093/intqhc/mzab039 [doi] AB - OBJECTIVE: To assess the reliability of the Institute for Healthcare Improvement's Global Trigger Tool (IHI-GTT) between nurses and medical students as primary reviewers to measure adverse events (AEs). DESIGN: Interrater reliability study. SETTING: A 500-bed general public hospital in Belo Horizonte, Brazil. PARTICIPANTS: A randomly selected sample of 220 hospital admissions of adults (>/=18 years) from Oct-Nov, 2016. INTERVENTION: Two 4th-5th year-medical students and two experienced nurses applied a Portuguese-translated version of the IHI-GTT to medical records. The role of medical reviewer was performed by two senior physicians specialists in Internal Medicine. MAIN OUTCOME MEASURES: Ability to identify AEs was compared between pairs and against medical reviewer through percentage inter-examiner agreement and Kappa coefficient (K). Two outcomes -- "AE identification" and "category of harm" -- were evaluated according to two different denominators -- "admissions" (the total number of admissions evaluated in the sample; reflects the presence or not of at least one AE in each admission) and "all possibilities of agreement" (obtained by adding each identified AE to the admissions without events; allows agreement assessment to be performed for each AE individually). RESULTS: Were identified 199 adverse events in 90 hospitalizations, with rates of 40.9% of admissions with AEs, 76.1 AEs/1,000 patient-days and 90.5 AEs/100 admissions. Comparing student-pair and nurse-pair, we found K = 0.76 (95% IC 0.62-0.88) and K = 0.17 (95% IC 0.06-0.27) for "AE identification" outcome and K = 0.28 (95% IC 0.01-0.55) and K = 0.46 (95% IC 0.28-0.64) for "category of harm" outcome to denominators "admission" and "all possibilities of agreement", respectively. There was no significant difference between the performances of the different primary reviewers composed in any analyses. CONCLUSION: IHI-GTT reliability varies considerably depending on the denominator used to calculate agreement. As the purpose of the tool is, in addition to measuring, promoting opportunities for quality of care improvement, the individual analysis of the AEs seems more appropriate. Further studies are needed to assess the implications of the slight agreement reached between primary reviewers on the test's overall accuracy. Moreover, advanced medical students may be considered for primary review in settings where unavailability of staff is a barrier to IHI-GTT adoption. CI - (c) The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. FAU - Moraes, Sara Monteiro AU - Moraes SM AD - Graduate Program in Sciences Applied to Adult Health, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil. AD - Hospital das Clinicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, MG 30130-100, Brazil. FAU - Ferrari, Teresa Cristina Abreu AU - Ferrari TCA AD - Graduate Program in Sciences Applied to Adult Health, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil. AD - Departamento de Clinica Medica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil. FAU - Figueiredo, Natalia Mansur Pimentel AU - Figueiredo NMP AD - Graduate Program in Sciences Applied to Adult Health, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil. AD - Hospital das Clinicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, MG 30130-100, Brazil. FAU - Almeida, Thais Novaes Costa AU - Almeida TNC AD - Graduate Program in Sciences Applied to Adult Health, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil. AD - Hospital das Clinicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, MG 30130-100, Brazil. FAU - Sampaio, Caio Cesar Lobo AU - Sampaio CCL AD - Graduate Program in Sciences Applied to Adult Health, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil. FAU - Andrade, Yane Cristine Pereira AU - Andrade YCP AD - Graduate Program in Sciences Applied to Adult Health, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil. FAU - Benedito, Regina Oliveira AU - Benedito RO AD - Hospital das Clinicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, MG 30130-100, Brazil. FAU - Beleigoli, Alline Maria AU - Beleigoli AM AD - Graduate Program in Sciences Applied to Adult Health, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil. AD - Caring Futures Institute, Flinders University, Sturt North N214, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia. LA - eng PT - Journal Article PL - England TA - Int J Qual Health Care JT - International journal for quality in health care : journal of the International Society for Quality in Health Care JID - 9434628 SB - IM MH - Adult MH - Brazil MH - Humans MH - *Medical Errors MH - *Patient Safety MH - Quality Indicators, Health Care MH - Reproducibility of Results MH - Retrospective Studies OTO - NOTNLM OT - Global Trigger Tool OT - adverse events OT - patient safety OT - quality of care EDAT- 2021/03/07 06:00 MHDA- 2021/07/29 06:00 CRDT- 2021/03/06 20:21 PHST- 2020/11/20 00:00 [received] PHST- 2021/01/26 00:00 [revised] PHST- 2021/03/01 00:00 [accepted] PHST- 2021/03/07 06:00 [pubmed] PHST- 2021/07/29 06:00 [medline] PHST- 2021/03/06 20:21 [entrez] AID - 6156294 [pii] AID - 10.1093/intqhc/mzab039 [doi] PST - ppublish SO - Int J Qual Health Care. 2021 Mar 18;33(1):mzab039. doi: 10.1093/intqhc/mzab039.