Estimates of rates of adverse events in hospitals depend on the methodology used. Manual chart reviews are cumbersome, time-consuming and labor-intense and grossly underestimate actual rates of adverse events. Use of trigger tools may help the process by identifying charts likely to have associated adverse events. The IHI Global Trigger Tool methodology is “doable” with limited resources and provides a more reliable comparison of adverse events over time. See our October 30, 2007 Patient Safety Tip of the Week “Using IHI's Global Trigger Tool” and our April 15, 2008 Patient Safety Tip of the Week “Computerizing Trigger Tools” for more details on how to use it.
Our May 2011 What’s New in the Patient Safety World column “Just How Frequent Are Hospital Medical Errors?” highlighted a study using IHI’s Global Trigger Tool to identify hospital adverse events (Classen 2011) that found that the rates of adverse events may be 10-fold higher than what was noted in the IOM report
Now a new study using a similar trigger tool assessed rates of adverse events in hospitalized pediatric patients in Canada (Matlow 2012). They used the Canadian Paediatric Trigger Tool, a validated tool similar to the IHI Global Trigger tool to identify charts for review in 8 academic pediatric medical centers and 14 community hospitals. The overall rate of adverse events was 9.2%. The overall rate of adverse events was almost 3 times higher in the academic centers but this was largely driven by a higher rate of non-preventable adverse events. Preventable adverse events occurred with roughly the same frequency in both settings. Surgery-related events predominated overall and were more common in the academic centers, whereas diagnostic errors were less frequent in academic centers.
The authors conclude that there are many opportunities to reduce harm affecting children in hospitals, particularly related to surgery, intensive care and diagnostic error.
Classen D, Resar R, Griffin F, et al. ‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured. Health Affairs 2011; 30(4): 581-589
Matlow AG, Baker GR, Flintoft V, et al. Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study. CMAJ 2012; July 30, 2012 First published July 30, 2012, doi: 10.1503/cmaj.112153
July 30, 2012