Risk and Preventability of Adverse Events at a Finnish Tertiary Hospital Using Modified Global Trigger Tool

Document Type: Research Paper


1 Kuopio University Hospital, Medical Center, Kuopio, Finland.

2 Kuopio University Hospital, Medical Administration, Kuopio, Finland and University of Eastern Finland, Kuopio campus, Kuopio, Finland.


Objective: To evaluate the risk and preventability of adverse events (AEs) at a 600-bed, tertiary teaching hospital in Kuopio, Finland.
Material and methods: The review of patient records was organized using the Institute for Healthcare Improvement’s Global Trigger Tool which was modified so that patient's point of view was emphasized. A bi-monthly random sample of hospital charts was selected between October 2014 and April 2016. The association with AEs of factors such as patients' age, sex, emergency vs. elective admission, multimedication, nursing care intensity raw points and categorized reasons for arrival were studied. A binary logistic regression model was employed to evaluate the risk of AEs.
Result: We found 140 AEs / 1000 patient days and 91 AEs / 100 admissions. Overall, 46 % of hospital admissions (n=305) had an AE.
Nursing care intensity raw points influenced the incidence of AEs (OR 1.238, P<0.001), and multimedication (OR 2.897, P=0.001) and nursing care intensity (OR 1.158, P=0.008) predicted preventable AEs.
The incidence of all and preventable AEs were significantly influenced by age group (≥65-year vs younger, OR 2.303, P Conclusion: Focusing on the patient's point of view, we found a high number of AEs in the study population. The risk for AE was influenced by age group ≥65 years and high nursing care intensity, especially in internal medicine/pulmonology and oncology. Efforts should be focused on these patients to improve patient safety.