Clinicians using a trigger tool can track overall harms and specific harms over time, and learn from past incidents and assess patient safety efforts, researchers say.
A new tool to retrospectively identify adverse events has the potential to make pediatric hospital care safer, research suggests.
Researchers at the AHRQ-funded Center of Excellence for Pediatric Quality Measurement at Boston Children's Hospital have developed and tested the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, which flags triggers, or clues, in the medical record that tip off medical professionals that an adverse event might have occurred.
"Triggers are the hint that may lead to finding an adverse event," David Stockwell, MD, medical director of the Pediatric ICU at the Children's National Health System, said in an online Boston Children's Hospital training video about the GAPPS tool.
For instance, a health record may show that a patient on insulin developed low blood sugar. This would prompt a healthcare worker to dig deeper into the medical record to determine why.
Perhaps the patient received an incorrect insulin dosage. Perhaps it was administered at the wrong time.
Using a trigger tool to retrospectively identify adverse events can allow hospitals to track overall harms and specific harms over time, as well as to learn from past incidents and assess patient safety efforts.
"Reliable measurement of adverse events is critical for providers to determine how effective efforts to improve pediatric patient safety are," the study's lead author, Christopher P. Landrigan, MD, MPH.
He is associate professor of pediatrics and medicine at Harvard Medical School and research director of the inpatient pediatrics service at Boston Children's Hospital, said in a statement.
Consistency
Trigger tools are also more sensitive and consistent than the traditional method of tracking adverse events: Voluntary reporting.
"Voluntary incident reporting captures only 2% to 8% of all adverse events, and exhaustive chart review methods can be resource-intensive."
Using trigger tools "allows for a faster assessment than a full chart review and a greater likelihood for detection of an adverse event than voluntary reporting," according to Boston Children's Hospital.
Drawing on previous work on trigger tools for adults, as well as literature review and the use of expert panels, researchers worked to identify which triggers to include in the tool.
They wanted to include triggers that had a relatively high likelihood of signaling an adverse event. They outlined their efforts in a study published in Pediatrics.
The tool was then field tested at 16 academic and community hospitals in the U.S.
Nurses, physicians, and in some cases, outside experts, reviewed 3,814 medical records to determine how well each of the triggers worked at identifying suspected adverse events.
As reviewers got more experienced, they got better at identifying the presence or absence of a suspected adverse event.
After testing, the refined tool included 27 manual triggers (ones identified by healthcare providers manually reviewing the medical record) and 30 automated triggers (automated from EHRs).
The finalized trigger list after the study included only triggers that identified adverse events in at least 10% of instances, according to the Boston Children's Hospital training video.
"This tool will help doctors and other practitioners caring for children to develop safer practices," said AHRQ Director Andy Bindman, MD, in a statement.
"A reliable trigger tool will help clinicians recognize potential safety concerns quickly from routine information collected from the medical record. Making providers aware of this information will help them avoid similar mistakes in the future."
Alexandra Wilson Pecci is an editor for HealthLeaders.
