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Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
Linköpings Universitetssjukhus.
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköpings Universitet.ORCID iD: 0000-0002-0961-5250
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2013 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, p. e003131-Article in journal (Refereed) Published
Abstract [en]

Objectives The aim was to describe the strengths and weaknesses, from team member perspectives, of working with the Global Trigger Tool (GTT) method of retrospective record review to identify adverse events causing patient harm.

Design A qualitative, descriptive approach with focus group interviews using content analysis.

Setting 5 Swedish hospitals in 2011.

Participants 5 GTT teams, with 5 physicians and 11 registered nurses.

Intervention 5 focus group interviews were carried out with the five teams. Interviews were taped and transcribed verbatim.

Results 8 categories emerged relating to the strengths and weaknesses of the GTT method. The categories found were: Usefulness of the GTT, Application of the GTT, Triggers, Preventability of harm, Team composition, Team tasks, Team members’ knowledge development and Documentation. Gradually, changes in the methodology were made by the teams, for example, the teams reported how the registered nurses divided up the charts into two sets, each being read respectively. The teams described the method as important and well functioning. Not only the most important, but also the most difficult, was the task of bringing the results back to the clinic. The teams found it easier to discuss findings at their own clinics.

Conclusions The GTT method functions well for identifying adverse events and is strengthened by its adaptability to different specialties. However, small, gradual methodological changes together with continuingly developed expertise and adaption to looking at harm from a patient's perspective may contribute to large differences in assessment over time.

Place, publisher, year, edition, pages
2013. Vol. 3, p. e003131-
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-30422DOI: 10.1136/bmjopen-2013-003131ISI: 000330541900016Scopus ID: 2-s2.0-84885339860OAI: oai:DiVA.org:lnu-30422DiVA, id: diva2:664263
Available from: 2013-11-14 Created: 2013-11-14 Last updated: 2017-12-06Bibliographically 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. p. 57
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

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Schildmeijer, KristinaPerk, JoepÅrestedt, KristoferNilsson, Gunilla

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