Detection of adverse events in surgical patients using the Trigger Tool approach

Background: Most studies of healthcare complications identify surgery as a major contributor to the overall burden of complicated care that leads to injury or death. Indeed, surgical adverse events account for one-half to three-quarters of all adverse events in these studies. Despite the intensive current focus on improving medical quality and safety, only a minority of quality improvement efforts are focused on surgery. This study reports on the development and testing of a Trigger Tool to detect adverse events among patients undergoing inpatient surgery. Methods: Rather than relying on traditional voluntary reporting for safety outcome measures such as incident reports, surgical peer review, or morbidity and mortality conferences, the Institute for Healthcare Improvement (IHI) has employed a new method for the detection of surgical adverse events (SAEs). This approach, commonly referred to as the “Trigger Tool”, identifies adverse events using a form of retrospective record review that has been developed and implemented in many areas of care. Results: During a 12-month IHI Perioperative Safety Collaborative, 11 hospitals voluntarily submitted data from surgical inpatient record reviews. In 854 patients, 138 SAEs were detected in 125 records for a rate of 16 SAEs per 100 patients or 14.6% of patients; 61 (44%) of these events contributed to increased length of stay or readmission and 12 (8.7%) events required life-saving intervention or resulted in permanent harm or death. Hospital review teams reported verbally that most of the events identified during the Trigger Tool review process had not been detected or reported via any other existing mechanism. Conclusions: The IHI Surgical Trigger Tool may offer a practical, easy-to-use approach to detecting safety problems in patients undergoing surgery; it can be the basis not only for estimating the frequency of adverse events in an organisation, but also determining the impact of interventions that focus on reducing adverse events in surgical patients.

[1]  R. Resar,et al.  A trigger tool to identify adverse events in the intensive care unit. , 2006, Joint Commission journal on quality and patient safety.

[2]  P. Basch.  Quality of health care delivered to adults in the United States. , 2003, New England Journal of Medicine.

[3]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[4]  D. Bratzler.  The Surgical Infection Prevention and Surgical Care Improvement Projects: Promises and Pitfalls , 2006, The American surgeon.

[5]  Elizabeth Olmsted Teisberg,et al.  How physicians can change the future of health care. , 2007, JAMA.

[6]  R. Resar,et al.  Adverse drug event trigger tool: a practical methodology for measuring medication related harm , 2003, Quality & safety in health care.

[7]  T. Jackson,et al.  Adverse events in Victorian admissions for elective surgery. , 2006, Australian health review : a publication of the Australian Hospital Association.

[8]  F Dean Griffen,et al.  The American College of Surgeons' closed claims study: new insights for improving care. , 2007, Journal of the American College of Surgeons.

[9]  T. Brennan,et al.  Ambulatory care adverse events and preventable adverse events leading to a hospital admission , 2007, Quality and Safety in Health Care.

[10]  T. Osler,et al.  Complications in surgical patients. , 2002, Archives of surgery.

[11]  Bruce Landon,et al.  Paying for quality: providers' incentives for quality improvement. , 2004, Health affairs.

[12]  C. Clancy,et al.  Improving patient safety--five years after the IOM report. , 2004, The New England journal of medicine.

[13]  R. Bellomo,et al.  Postoperative serious adverse events in a teaching hospital: a prospective study , 2002, The Medical journal of Australia.

[14]  P. Maurette,et al.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[15]  D M Berwick,et al.  Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change , 2006, Quality and Safety in Health Care.

[16]  S. Duckett,et al.  The incidence and cost of cardiac surgery adverse events in Australian (Victorian) hospitals 2003–2004 , 2007, The European Journal of Health Economics.

[17]  A. Gawande,et al.  The incidence and nature of surgical adverse events in Colorado and Utah in 1992. , 1999, Surgery.

[18]  D. Classen,et al.  Methodology and rationale for the measurement of harm with trigger tools , 2003, Quality & safety in health care.

[19]  R. Bellomo,et al.  The epidemiology of major early adverse physiological events after surgery. , 2000, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[20]  F. Davidoff,et al.  What is “quality improvement” and how can it transform healthcare? , 2007, Quality and Safety in Health Care.

[21]  G. Hackbarth,et al.  Quality in Medicare: From Measurement to Payment and Provider to Patient , 2005, Health care financing review.

[22]  Paul J Sharek,et al.  Adverse Events in the Neonatal Intensive Care Unit: Development, Testing, and Findings of an NICU-Focused Trigger Tool to Identify Harm in North American NICUs , 2006, Pediatrics.