lnu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Assessment of adverse events in medical care: lack of consistency between experienced teams using the global trigger tool.
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.ORCID iD: 0000-0002-0961-5250
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
2012 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 21, no 4, 307-314 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Many patients are harmed as the result of healthcare. A retrospective structured record review is one way to identify adverse events (AEs). One such review approach is the global trigger tool (GTT), a consistent and well-developed method used to detect AEs. The GTT was originally intended to be used for measuring data over time within a single organisation. However, as the method spreads, it is likely that comparisons of GTT safety outcomes between hospitals will occur.

OBJECTIVE: To evaluate agreement in judgement of AEs between well-trained GTT teams from different hospitals.

METHODS: Five teams from five hospitals of different sizes in the southeast of Sweden conducted a retrospective review of patient records from a random sample of 50 admissions between October 2009 and May 2010. Inter-rater reliability between teams was assessed using descriptive and κ statistics.

RESULTS: The five teams identified 42 different AEs altogether. The number of identified AEs differed between the teams, corresponding to a level of AEs ranging from 27.2 to 99.7 per 1000 hospital days. Pair-wise agreement for detection of AEs ranged from 88% to 96%, with weighted κ values between 0.26 and 0.77. Of the AEs, 29 (69%) were identified by only one team and not by the other four groups. Most AEs resulted in minor and transient harm, the most common being healthcare-associated infections. The level of agreement regarding the potential for prevention showed a large variation between the teams.

CONCLUSIONS: The results do not encourage the use of the GTT for making comparisons between hospitals. The use of the GTT to this end would require substantial training to achieve better agreement across reviewer teams.

Place, publisher, year, edition, pages
2012. Vol. 21, no 4, 307-314 p.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-21843DOI: 10.1136/bmjqs-2011-000279PubMedID: 22362917Scopus ID: 2-s2.0-84858753104OAI: oai:DiVA.org:lnu-21843DiVA: diva2:557750
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Aspects of retrospective record review: - A matter of patient safety
Open this publication in new window or tab >>Aspects of retrospective record review: - A matter of patient safety
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2013. 57 p.
Series
Linnaeus University Dissertations, 153/2013
National Category
Medical and Health Sciences
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-30428 (URN)978-91-87427-61-9 (ISBN)
Public defence
2013-12-06, V159, Stagneliusgatan 14, Kalmar, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2013-11-25 Created: 2013-11-14 Last updated: 2013-11-25Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMedScopus

Authority records BETA

Schildmeijer, KristinaÅrestedt, KristoferPerk, Joep

Search in DiVA

By author/editor
Schildmeijer, KristinaÅrestedt, KristoferPerk, Joep
By organisation
School of Health and Caring Sciences
In the same journal
BMJ Quality and Safety
Health Care Service and Management, Health Policy and Services and Health Economy

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 273 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf