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

Unbeck, Maria; Schildmeijer, Kristina; Henriksson, Peter; Jürgensen, Urban; Muren, Olav; Nilsson, Lena; Pukk Härenstam, Karin

doi:10.1186/1754-9493-7-10

Patient Safety in Surgery

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

AE, adverse events; PPV, positive predictive value.
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.
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.
The five GTT perinatal triggers were not applicable in this study.

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ISSN: 1754-9493

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