This article, titled “Application of Global Trigger Tools in University Hospital and Comparison to Volunteer Adverse Events Reporting System“, delves into a critical aspect of patient safety: the accurate detection and reporting of adverse events (AEs) in healthcare settings. Authored by Zeynep Ekici, Mehmet Nurullah Kurutkan, and Mustafa Ayhan Ekici, and published in Clin. Lab. 2/2024, this study offers significant insights into the efficacy of modern AE detection methods compared to traditional systems.
The core problem addressed by the researchers is the significant underreporting of adverse events in healthcare. While a Voluntary Reporting System (VRS) is still widely used in many countries to identify AEs, public health experts have determined that it typically only reports 10-20% of AEs. Moreover, the vast majority (90-95%) of AEs reported through VRS do not cause patient harm. A major limitation of VRS is its under-reporting of serious AEs, partly due to healthcare professionals fearing repercussions for errors, and its limited categories for reporting outcomes like disability or death.
To overcome these limitations, the study explores the Global Trigger Tool (GTT), developed by the American Institute for Health Improvement (IHI) in 2009. The GTT is recognized as one of the most effective techniques for detecting AEs. It involves a retrospective examination of randomly selected hospital records to identify AEs and assess the level of harm. The GTT encompasses six modules (health services, medicine, surgery, intensive care, perinatal, and emergency departments) and 54 triggers. Crucially, GTT focuses on all AEs that cause patient harm, regardless of whether they resulted from an error, specifically categorizing them between Categories E and I on the NCC-MERP scale.
This retrospective cross-sectional study marks the first application of the GTT in an Obstetrics and Gynecology Clinic (OGC) in the authors’ country. The researchers reviewed 240 inpatient records from a total of 1,807 OGC patient files between August 2018 and August 2020. The study also uniquely investigated the potential for new, OGC-specific triggers, such as postoperative CRP elevations and vaginal Dinoprostone (Propess) use.
The findings unequivocally demonstrate the superior detection capabilities of the GTT. The study revealed that the number of AEs detected using GTT was 8.3 times higher than with the VRS. Specifically, GTT identified 83 AEs in 23 patients out of the 240 reviewed records, meaning 9.58% of hospitalizations had at least one AE. In stark contrast, the VRS for the same period reported only 10 E-category AEs (mostly related to patient falls and medical device safety), and zero F-category AEs. The GTT detected 45 E-category and 35 F-category AEs, highlighting its effectiveness in uncovering both temporary harms requiring intervention (E) and those necessitating prolonged hospitalization (F).
The research also identified several highly sensitive triggers (PPV = 100%) including healthcare-related infection, complications from any procedure, APTT > 100 seconds, INR > 6, organ injury, and all kinds of operative complications. Furthermore, the investigation into new triggers proved fruitful: vaginal Dinoprostone (Propess) use had a Positive Predictive Value (PPV) of 30%, detecting AEs like fetal distress and postpartum uterine bleeding, while CRP elevation had a PPV of 22%, indicating rehospitalization for infections.
In conclusion, the article strongly advocates for the GTT as a more effective and reliable tool for detecting AEs than the VRS, particularly when adapted to departmental practices. It serves as a credible and fruitful instrument for patient safety improvement and underscores the urgent need for more robust AE detection methods beyond voluntary reporting. The authors recommend further multi-center studies with larger datasets to generalize these important findings.
Reference: Ekici, Z., Kurutkan, M. N., & Ekici, M. A. (2024). Application of Global Trigger Tools in University Hospital and Comparison to Volunteer Adverse Events Reporting System. Clin. Lab., 70(2), XXX-XXX. https://doi.org/10.7754/Clin.Lab.2023.230641
