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Table 4 Outcome of the respective trigger in relation to the adverse event

From: Is detection of adverse events affected by record review methodology? an evaluation of the “Harvard Medical Practice Study” method and the “Global Trigger Tool”

Triggers n(%) of positive triggers n of triggers related to AE PPV AE
Procedure 117 (15.9) 25 21.4
Care: other 106 (14.4) 30 28.3
Anti-emetic administration 74 (10.0) 1 1.4
Abrupt drop in haemoglobin 66 (9.0) 2 3.0
Occurrence of any postoperative complication 64 (8.7) 49 76.6
Healthcare-associated infections 60 (8.1) 34 56.7
Re-admission within 30 days 59 (8.0) 13 22.0
Pressure ulcers 33 (4.5) 25 75.8
Return to surgery 21 (2.8) 8 38.1
Falls 16 (2.2) 3 18.8
Transfusion of blood or use of blood products 15 (2.0) 1 6.7
Abrupt medication stop 14 (1.9) 2 14.3
Change of anaesthetic during surgery 13 (1.8) 1 7.7
Removal/injury or repair of organ during operative procedure 10 (1.4) 3 30.0
Vitamin K administration 9 (1.2) 0 0.0
Change in procedure 8 (1.1) 5 62.5
X-ray or Doppler studies for emboli or deep vein thrombosis 7 (0.9) 6 85.7
Codes or arrest 7 (0.9) 3 42.9
Transfer to higher level of care 6 (0.8) 4 66.7
Re-admission to the Emergency Department (ED) within 48 hours 6 (0.8) 1 16.7
Diphenhydramine administration 4 (0.5) 1 25.0
Over-sedation/hypotension 3 (0.4) 2 66.7
Insertion of arterial or central venous line during surgery 3 (0.4) 0 0.0
Post-operative increase in troponin levels 2 (0.3) 2 100.0
Intubation/reintubation / BiPaP in post anaesthesia care unit 2 (0.3) 0 0.0
Consult requested in post anaesthesia care unit 2 (0.3) 0 0.0
Time in ED greater than 6 hours 2 (0.3) 0 0.0
Naloxone administration 2 (0.3) 1 50.0
Clostridium difficile positive stool 1 (0.1) 1 100.0
Admission to intensive care post-operatively 1 (0.1) 1 100.0
Positive blood culture 1 (0.1) 0 0.0
International Normalised Ratio (INR) greater than 6 1 (0.1) 0 0.0
Glucose less than 3 mmol/litre 1 (0.1) 0 0.0
Rising BUN or serum creatinine two times (2x) over baseline 1 (0.1) 0 0.0
Total 737 (100) 224 30.4
  1. AE, adverse events; PPV, positive predictive value.
  2. None of the triggers in the Intensive Care Module (pneumonia onset, readmission to intensive care unit, in-unit procedure or intubation/re-intubation) were identified in this study.
  3. None of the following triggers were identified in this study; In hospital stroke, dialysis, X-ray intra-operative or in post anaesthesia care unit, intra- or postoperative death, mechanical ventilation greater than 24 h post-operatively, intra-operative administration of Epinephrine, Norepinephrine, Naloxone or Flumazenil, pathology reports normal or identifying specimen unrelated to initial surgical diagnosis, operative time greater than 6 h, partial thromboplastin time greater than 100 seconds, and Flumazenil administration.
  4. The five GTT perinatal triggers were not applicable in this study.