Most systems for measuring medical errors rely on voluntary reporting of errors and nearmiss events. The IHI Global Trigger Tool (IHIGTT) is a manual retrospective review of a random sample of inpatient hospital records using validated set of triggers to detect adverse events and measure their rate over time. The IHIGTT focuses on those adverse events related to the active delivery of care.
Triggers are defined as occurrences found on review of medical record that suggest focussed further investigation to ascertain an adverse event. Per IHI, Adverse events (AEs) are defined as unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment or hospitalization, or that results in death. The inclusion criteria include: adult patients, closed and complete records; and the length of stay at least 24 h and formally admitted to the hospital. Every 2 weeks, 10 charts were randomly selected. A 20min limit was set for review of each patient record to eliminate selection bias. The review team consisted of three reviewers: a pharmacist and a nurse from Nursing Quality and a physician The team reached a final agreement on the type, number and severity of events. The Severity scale was based on the NCC MERP Index for categorizing errors. The primary objective was to asses the frequency of the Adverse Events among the adult population at a Tertiary Care Center. Frequency was defined in two ways: AEs/1,000 patient day and AEs/100 admissions. The secondary objective was to compare the characteristics and the frequency of AEs detected to the ones reported using voluntary reporting system.
Of the 53,102 eligible admissions between February 2010 and February 2011, 260 randomly selected patients’ records were reviewed; 1067 triggers and 192 adverse events were identified. Top triggers associated with adverse events include any operative complication, decrease in hemoglobin > 25%, any procedure complication, readmission within 30 days, PTT > 100 s, investigations for DVT/PE. Top AEs include DVT, intraop blood loss, pressure ulcers, healthcare associate infections, atrial fibrillation, bleeding from incisional site, hypoglycemia and return to surgery. There were 108 adverse events per 1,000 patient days as compared to 90 AEs per external IHI benchmark and 8 AEs by SERS. The AEs most commonly identified by IHIGTT but missed by SERS were in F catergory of NCCMERP scale. Increased AEs correlated with longer length of stay.
The IHI Global Trigger Tool is a measurement tool and should be utilised as a springboard to identify areas to focus resources to positively impact patient care and safety. The implementation of this methodology has revealed certain adverse events that are routinely missed using the voluntary reporting system. Continued implementation of IHI Global Trigger Tool will be utilized to assess the effect of various initiatives to increase patient safety and decrease adverse events.
To cite this abstract:Bulgar A, McHugh R, Kandpal S. Ihi Global Trigger Tools and Adverse Events. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97565. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/ihi-global-trigger-tools-and-adverse-events/. Accessed September 17, 2019.