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Is detection of adverses events affected by record review merthodology? an evaluation of the "Harvard medical practice study" method and the "Global trigger tool"
Karolinska Institutet.
Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).ORCID-id: 0000-0002-0895-674X
Karolinska Institutet.
Eksjö sjukhus.
Vise andre og tillknytning
2013 (engelsk)Inngår i: Patient Safety in Surgery, ISSN 1754-9493, E-ISSN 1754-9493, Vol. 7, nr April, s. Article ID: 10-Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background

There has been a theoretical debate as to which retrospective record review method is the most valid, reliable, cost efficient and feasible for detecting adverse events. The aim of the present study was to evaluate the feasibility and capability of two common retrospective record review methods, the “Harvard Medical Practice Study” method and the “Global Trigger Tool” in detecting adverse events in adult orthopaedic inpatients.

Methods

We performed a three-stage structured retrospective record review process in a random sample of 350 orthopaedic admissions during 2009 at a Swedish university hospital. Two teams comprised each of a registered nurse and two physicians were assigned, one to each method. All records were primarily reviewed by registered nurses. Records containing a potential adverse event were forwarded to physicians for review in stage 2. Physicians made an independent review regarding, for example, healthcare causation, preventability and severity. In the third review stage all adverse events that were found with the two methods together were compared and all discrepancies after review stage 2 were analysed. Events that had not been identified by one of the methods in the first two review stages were reviewed by the respective physicians.

Results

Altogether, 160 different adverse events were identified in 105 (30.0%) of the 350 records with both methods combined. The “Harvard Medical Practice Study” method identified 155 of the 160 (96.9%, 95% CI: 92.9-99.0) adverse events in 104 (29.7%) records compared with 137 (85.6%, 95% CI: 79.2-90.7) adverse events in 98 (28.0%) records using the “Global Trigger Tool”. Adverse events “causing harm without permanent disability” accounted for most of the observed difference. The overall positive predictive value for criteria and triggers using the “Harvard Medical Practice Study” method and the “Global Trigger Tool” was 40.3% and 30.4%, respectively.

Conclusions

More adverse events were identified using the “Harvard Medical Practice Study” method than using the “Global Trigger Tool”. Differences in review methodology, perception of less severe adverse events and context knowledge may explain the observed difference between two expert review teams in the detection of adverse events.

sted, utgiver, år, opplag, sider
BioMed Central, 2013. Vol. 7, nr April, s. Article ID: 10-
Emneord [en]
Adverse event, safety, retrospective record review, orthopaedic care
HSV kategori
Forskningsprogram
Hälsovetenskap, Vårdvetenskap
Identifikatorer
URN: urn:nbn:se:lnu:diva-30426DOI: 10.1186/1754-9493-7-10Scopus ID: 2-s2.0-84877036871OAI: oai:DiVA.org:lnu-30426DiVA, id: diva2:664275
Tilgjengelig fra: 2013-11-14 Laget: 2013-11-14 Sist oppdatert: 2019-04-12bibliografisk kontrollert
Inngår i avhandling
1. Aspects of retrospective record review: - A matter of patient safety
Åpne denne publikasjonen i ny fane eller vindu >>Aspects of retrospective record review: - A matter of patient safety
2013 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Background: Health Care is of great value but despite increased efforts to improve patient safety, many patients still suffer harm caused by healthcare, and even more patients have encountered incidents that could have caused harm. Adverse events can be detected by using retrospective record review. The Harvard Medical Practice Study and the Global Trigger Tool are such methods. Retrospective record review has shown better coverage than the commonly used clinical incident reporting system to identify patient safety information.

Aims: The general aim of the thesis was to evaluate, compare and expand retrospective record review methods for clinical use in health care. The specific aims were;

  • To evaluate the agreement in judgments of adverse events between well-trained Global Trigger Tool teams from different hospitals.
  • To describe strengths and weaknesses, from team members perspectives of working with the Global Trigger Tool method of retrospective record review to identify adverse events causing patient harm.
  • To evaluate the feasibility and capability of two common retrospective record review methods, the "Harvard Medical Practice Study" method and the "Global Trigger Tool" in detecting adverse events in adult orthopedic inpatients.
  • To evaluate retrospective record review for the detection and characterization of no-harm incidents and compare findings with conventional incident reporting systems.

Methods: A random sample of fifty patient records was reviewed by a team from each of five hospitals according to the Global Trigger Tool method (I). The teams were interviewed in focus groups concerning their experiences of the Global Trigger Tool method (II). In papers III and IV, a random sample of 350 orthopaedic admissions was examined. The outcomes from the Harvard Medical Practice Study and the Global Trigger Tool methods were compared (III). In paper IV the Harvard Medical Practice Study method was also used for identifying no harm incidents.

Results: The number of identified adverse events differed between the teams, corresponding to a level of adverse events ranging from 27.2 to 99.7 per 1000 hospital days. Differences were also found in the assessment of level of harm and judgment of preventability. Four of the teams made similar assessments while the fifth identified three times as many adverse events compared to the other teams (I).

Eight categories with their strengths and weaknesses emerged from the focus group interviews. The team members were constant in their generally positive experiences of the Global Trigger Tool method, even if the teams over time altered the application of the method (II).

With the Harvard Medical Practice Study and the Global Trigger Tool methods combined, 160 adverse events were identified in 105 (30%) of the 350 records. The Harvard Medical Practice Study method identified 155 (97%) adverse events in 104 of 350 records compared with 137 (86%) adverse events in 98 records using the Global Trigger Tool method. The adverse events causing the greatest differences were the ones causing minimal or moderate impairment (III).

In paper IV, results showed that 118 no harm incidents were detected in 91 (26%) of the 350 patient records. Ninety-four of the 118 (80%) no-harm incidents were classified as preventable. Sixteen no-harm incidents were identified by the five conventional incident reporting systems. Of these, ten no-harm incidents were also found by the Harvard Medical Practice Study method.

Conclusions: Retrospective record review enabled detection of adverse events as well as identification of no harm incidents. It is considered a useful method. There were differences both in agreement between reviewer teams and between review methods. Joint preparations and discussions seemed to increase the level of agreement in judgment between reviewers. By adding retrospective record review for findings of no-harm incidents to conventional incident reporting, healthcare providers can gain new important information about commonly occurring, no-harm incidents in order to improve patient safety.

sted, utgiver, år, opplag, sider
Växjö: Linnaeus University Press, 2013. s. 57
Serie
Linnaeus University Dissertations ; 153/2013
HSV kategori
Forskningsprogram
Hälsovetenskap, Vårdvetenskap
Identifikatorer
urn:nbn:se:lnu:diva-30428 (URN)978-91-87427-61-9 (ISBN)
Disputas
2013-12-06, V159, Stagneliusgatan 14, Kalmar, 09:30 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2013-11-25 Laget: 2013-11-14 Sist oppdatert: 2019-04-12bibliografisk kontrollert

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