Article Text

other Versions

PDF
Assessment of adverse events in medical care: lack of consistency between experienced teams using the global trigger tool
  1. Kristina Schildmeijer1,
  2. Lena Nilsson2,3,
  3. Kristofer Årestedt1,4,
  4. Joep Perk1
  1. 1School of Health and Caring Sciences, Faculty of Health, Social Work and Behavioural Sciences, Linnaeus University, Kalmar, Sweden
  2. 2Division of Drug Research, Anaesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköping, Sweden
  3. 3Department of Anesthesia and Intensive Care, County Council of Östergötland, Linköping, Sweden
  4. 4Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  1. Correspondence to Kristina Schildmeijer, Linnaéus University, School of Health and Caring Sciences, Kalmar 39182, Sweden; kristina.schildmeijer{at}lnu.se

Abstract

Background Many patients are harmed as the result of healthcare. A retrospective structured record review is one way to identify adverse events (AEs). One such review approach is the global trigger tool (GTT), a consistent and well-developed method used to detect AEs. The GTT was originally intended to be used for measuring data over time within a single organisation. However, as the method spreads, it is likely that comparisons of GTT safety outcomes between hospitals will occur.

Objective To evaluate agreement in judgement of AEs between well-trained GTT teams from different hospitals.

Methods Five teams from five hospitals of different sizes in the southeast of Sweden conducted a retrospective review of patient records from a random sample of 50 admissions between October 2009 and May 2010. Inter-rater reliability between teams was assessed using descriptive and κ statistics.

Results The five teams identified 42 different AEs altogether. The number of identified AEs differed between the teams, corresponding to a level of AEs ranging from 27.2 to 99.7 per 1000 hospital days. Pair-wise agreement for detection of AEs ranged from 88% to 96%, with weighted κ values between 0.26 and 0.77. Of the AEs, 29 (69%) were identified by only one team and not by the other four groups. Most AEs resulted in minor and transient harm, the most common being healthcare-associated infections. The level of agreement regarding the potential for prevention showed a large variation between the teams.

Conclusions The results do not encourage the use of the GTT for making comparisons between hospitals. The use of the GTT to this end would require substantial training to achieve better agreement across reviewer teams.

Statistics from Altmetric.com

Footnotes

  • Funding FORSS—the research council of the southeast of Sweden and the County Council of Kalmar (grant number 72521).

  • Competing interests None.

  • Ethics approval The ethics board at Linköping University, Sweden (study number 2010/56-31).

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.