PMID- 36715067
OWN - NLM
STAT- MEDLINE
DCOM- 20230303
LR  - 20230303
IS  - 1464-3677 (Electronic)
IS  - 1353-4505 (Linking)
VI  - 34
IP  - 1
DP  - 2023 Feb 28
TI  - The accuracy of the Global Trigger Tool is higher for the identification of 
      adverse events of greater harm: a diagnostic test study.
LID - mzad005 [pii]
LID - 10.1093/intqhc/mzad005 [doi]
AB  - Global Trigger Tool (GTT) of the Institute for Healthcare Improvement (IHI) has 
      been used as a measurement strategy for patient safety by several institutions 
      and national programs. Although the greater ability of the GTT to identify 
      adverse events (AEs) compared to other methods has already been demonstrated, 
      there are few data on its accuracy, and studies suggest lower sensitivity for 
      minor AEs. This study aimed to assess the accuracy of the GTT for identifying AEs 
      in adult inpatients for all AEs and for the subgroup of AEs with greater harm to 
      the patient, classified as F-I on the IHI-GTT adapted version of the National 
      Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) 
      Index for Categorizing Errors. In this diagnostic test study, GTT is the index 
      test and identification of AEs (yes/no) represents the condition of interest. Due 
      to the lack of a gold standard test, a composite reference standard method was 
      developed. Reference standard method combined real-time (during hospitalizations) 
      and retrospective search of medical records and administrative data for screening 
      criteria and AEs. Both tests were applied to a random sample of 211 
      hospitalizations of adult inpatients during October-November 2016 in a large 
      public hospital in Belo Horizonte, Brazil. The accuracy of the GTT was evaluated 
      using sensitivity, specificity, and global accuracy. A total of 176 AEs were 
      identified in 67 admissions using reference standard method and 129 AEs in 76 
      admissions using GTT, resulting in rates of 126 and 93 AEs/1000 patient-days, 
      respectively. Sensitivity, specificity, and global accuracy of the GTT for the 
      identification of individual AEs were, respectively, 0.41 (95% confidence 
      interval [CI] 0.34; 0.49), 0.68 (95% CI 0.60; 0.74), and 0.54 (95% CI 0.49; 0.60) 
      for all AEs, regardless of the harm categorization, and 0.85 (95% CI 0.72; 0.93), 
      0.88 (95% CI 0.82; 0.92), and 0.87 (95% CI 0.82; 0.91) for the subgroup of AEs 
      categorized as harm F-I. Among the main AEs missed by the GTT are AEs related to 
      nursing care, such as those related to peripheral venous access and 
      gastric/enteric catheters. GTT proved to be a valid method for identifying AEs in 
      adult inpatients. Its accuracy increases when minor harm AEs are not counted. 
      Among the main AEs missed by the GTT are those related to nursing care. 
      Therefore, the GTT should be used in conjunction with other measurement 
      strategies to achieve results that are representative of the quality profile of 
      the care provided and, thus, guide the best improvement strategies.
CI  - (c) The Author(s) 2023. 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
AUID- ORCID: 0000-0001-9614-1884
AD  - Departamento de Clinica Medica, Faculdade de Medicina, Universidade Federal de 
      Minas Gerais, Avenida Alfredo Balena, 190, Santa Efigenia, Belo Horizonte, Minas 
      Gerais 30130100, Brazil.
FAU - Ferrari, Teresa Cristina Abreu
AU  - Ferrari TCA
AD  - Departamento de Clinica Medica, Faculdade de Medicina, Universidade Federal de 
      Minas Gerais, Avenida Alfredo Balena, 190, Santa Efigenia, Belo Horizonte, Minas 
      Gerais 30130100, Brazil.
FAU - Beleigoli, Alline
AU  - Beleigoli A
AD  - Caring Futures Institute, Flinders University, N306 Sturt North, Bedford Park, 
      Adelaide, South Australia 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  - Humans
MH  - *Medical Errors/prevention & control
MH  - Retrospective Studies
MH  - *Quality Indicators, Health Care
MH  - Medication Errors
MH  - Patient Safety
MH  - Diagnostic Tests, Routine
OTO - NOTNLM
OT  - adverse Events
OT  - global Trigger Tool
OT  - patient Safety
EDAT- 2023/01/31 06:00
MHDA- 2023/03/04 06:00
CRDT- 2023/01/30 05:43
PHST- 2022/07/17 00:00 [received]
PHST- 2022/11/21 00:00 [revised]
PHST- 2023/01/26 00:00 [accepted]
PHST- 2023/01/31 06:00 [pubmed]
PHST- 2023/03/04 06:00 [medline]
PHST- 2023/01/30 05:43 [entrez]
AID - 7008723 [pii]
AID - 10.1093/intqhc/mzad005 [doi]
PST - ppublish
SO  - Int J Qual Health Care. 2023 Feb 28;34(1):mzad005. doi: 10.1093/intqhc/mzad005.