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

Document Type : Research Paper

Authors

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.

Abstract

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.

Keywords

References

  1. Ministry of Social Affairs and Health. Government resolution. Patient and client safety strategy 2017-2021. Publications 2017:11. http://urn.fi/URN:ISBN:978-952-00-3958-5.
  2. Adler L, Yi D, Li M, McBroom B, Hauck L, Sammer C et al. Impact of Inpatient Harms on Hospital Finances and Patient Clinical Outcomes. J Patient Saf 2018;14(2):67-73. doi:10. 1097/PTS. 00000000000001.
  3. Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press 2013. https:// doi.org/ 10.17226/13444.
  4. von Plessen C, Kodal AM, Anhøj J. Experiences with global trigger tool reviews in five Danish hospitals: an implementation study. BMJ Open 2012;2:e001324. doi: 10.1136/ bmjopen-2012-001324.
  5. Rutberg H, Borgstedt-Risberg M, Gustafson P, Unbeck M. Adverse events in orthopedic care identified via the Global Trigger Tool in Sweden – implications on preventable prolonged hospitalizations.Patient Saf Surg 2016;10:23. doi:10.1186/s13037-016-0112-y.
  6. Rutberg H, Borgstedt-Risberg M, Sjödahl R, Nordqvist P, Valter L, Nilsson L. Characterizations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method.  BMJ Open 2014; 4(5): e004879.doi:10.1136/bmjopen-2014-004879.
  7. Mevik K, Griffin FA, Hansen TE, Deilkås ET, Vonen B. Does increasing the size of bi-weekly samples of records influence results when using the Global Trigger Tool? An observational study of retrospective record reviews of two different sample sizes. BMJ Open 2016;6(4):e010700. doi: 10.1136/bmjopen-2015-010700.
  8. Deilkås ET, Borgstedt Risberg M, Haugen M, Lindstrøm JC, Nylén U, Rutberg H et al.Exploring similarities and differences in hospital adverse event rates between Norway and Sweden using Global Trigger Tool. BMJ Open 2017;7: e012492.  doi: 10.1136/bmjopen-2016-012492.
  9. Haukland EC, von Plessen C, Nieder C, Vonen B. Adverse events in hospitalized cancer patients: a comparison to a general hospital population. Acta Oncol 2017;56(9):1218-1223. doi: 10.1080/0284186X.2017.1309063.
  10. Doupi P, Peltomaa K, Kaartinen M, Öhman J. IHI Global Trigger Tool and patient safety monitoring in Finnish hospitals - Current experiences and future trends. Report 2013_019. National Institute for Health and Welfare 2013. http://urn.fi/URN:ISBN:978-952-245-999-2.
  11. Järvelin, J. Studies on Filed and Compensated Claims for Patient Injuries. Academic Dissertation. National Institute for Health and Welfare. Tampere: Juvenes Print - Finnish University Print Ltd 2012. http:// urn.fi/URN:ISBN:978-952-245-750-9.
  12. Rafter N, Hickey A, Condell S, Conroy R, O'Connor P, Vaughan D, Williams D. Adverse events in healthcare: learning from mistakes. QJM.2015;108(4):273-277.doi:10. 1093/ qjmed/ hcu 145.
  13. Bates DW, Singh H. Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety. Health Aff (Millwood). 2018; 37(11):1736–1743.doi:10. 1377/ hlthaff.2018.0738.
  14. Wittich CM, Burkle CM, Lanier WL. Medication errors: an overview for clinicians. Mayo Clin Proc. 2014;89(8):1116–1125. doi: 10.1016/j.mayocp.2014.05.007.
  15. Griffin F, Resar R. IHI Global Trigger Tool for measuring adverse events. 2nd edn. Cambridge, Massachusetts: Institute for Healthcare Improvement 2009.
  16. Classen DC, Lloyd RC, Provost L, Griffin FA, Resar R. Development and evaluation of the institute for healthcare improvement global trigger tool. J Patient Saf 2008; 4(3):169-177. doi: 10.1097/PTS.0b013e318183a475.
  17. Kurutkan MN, Usta E, Orhan F, Simsekler MC. Application of the IHI Global Trigger Tool in measuring the adverse event rate in a Turkish healthcare setting. Int J Risk Saf Med. 2015;27(1):11-21.doi:10.3233/JRS-150639.
  18. Classen DC, Resar R, Griffin F, Federico F, Frankel T, Kimmel N et al. 'Global trigger tool' shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff (Millwood). 2011; 30(4):581-589. doi: 10.1377/hlthaff.2011.0190.
  19. Doupi P. Using EHR data for Monitoring and Promoting Patient Safety: Reviewing the Evidence on trigger Tools. In: Mantas J, et al, eds. Quality of Life through Quality of Information. IOS Press 2012:786-790. doi:10.3233/978-1-61499-101-4-786.
  20. Mayor S, Baines E, Vincent C, Lankshear A, Edwards A, Aylward M et al. Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study. Health Services and Delivery Research 2017;5(9):1-226. https:// www.ncbi. nlm.nih.gov/books/NBK424600/pdf/Bookshelf_NBK424600.pdf. doi:10.3310/hsdr05090.
  21. Hibbert PD, Molloy CJ, Hooper TD, Wiles LK, Runciman WB, Lachman P et al. The application of the Global Trigger Tool: a systematic review. Int J Qual Health Care 2016; 28(6):640-649. doi:10.1093/intqhc/mzw115.
  22. Rauhala A, Fagerström L. Determining optimal nursing intensity: the RAFAELA method. J Adv Nurs 2004 Feb;45(4):351-9.  https://doi. org/10.1046/j.1365-2648.2003.02918.x.
  23. Pérez ZA, Gutiérrez SM, Rodriquez CL, Andrés EE, Gómez A, Ruiz-López P. Detection of adverse events in general surgery using the " Trigger Tool" methodology. Cir Esp 2015; 93(2): 84-90. doi: 10.1016/j.ciresp.2014.08.007.
  24. Najjar S, Hamdan M, Euwema MC, Vleugels A, Sermeus W, Massoud R et al. The Global Trigger Tool shows that one out of seven patient suffers harm in Palestinian hospitals: challenges for launching a strategic safety plan. Int J Qual Health Care 2013;25(6):640-647. doi: 10.1093/intqhc/mzt066.
  25. Hwang JI, Chin HJ, Chang Y-S. Characteristics associated with the occurrence of adverse events: a retrospective medical record review using the Global Trigger Tool in a fully digitalized tertiary teaching hospital in Korea. J Eval Clin Pract 2014;20:27-35. doi: 10.1111/ jep.12075.
  26. Hwang JI, Kim J, Park JW. Adverse Events in Korean Traditional Medicine Hospitals: A Retrospective Medical Record Review. J Patient Saf 2015 May.doi:10.1097/PTS.0000000000000 190.
  27. Kennerly DA, Kudyakov R, da Graca B, Saldaña M, Compton J, Nicewander D et al. Characterization of Adverse Events Detected in a Large Health Care Delivery System Using an Enhanced Global Trigger Tool over a Five-Year Interval. Health Serv Res2014;49(5):1407-1425. doi: 10.1111/1475-6773.12163.
  28. Zhang E, Hung S-C, Wu C-H, Chen L-L, Tsai M-T, Lee W-H. Adverse event and error of unexpected life-threatening events within 24 h of emergency department admission. Am J Emerg Med 2017; 35(3):479-483. http://dx.doi. org/10.1016/j.ajem.2016.11.062.
  29. Statistics Finland. Available 28 May 2019 at: https://findikaattori.fi/en/81.
  30. Härkänen M, Kervinen M, Ahonen J, Voutilainen A, Turunen H, Vehviläinen-Julkunen K. Patient-specific risk factors of adverse drug events  in  adult  inpatients –  evidence   detected using the Global Trigger Tool method. J Clin Nurs 2015 Feb;24(3-4): 582-91.doi:10.1111/jocn. 12714.
  31. Fagerström L, Kinnunen M, Saarela J. Nursing workload, patient safety incidents and mortality: an observational study from Finland. BMJ Open 2018 Apr 24;8(4):e016367. doi: 10.1136/bmjopen-2017-016367.
  32. Lipczak H, Knudsen JL, Nissen A. Safety hazards in cancer care: findings using three different methods.  BMJ Qual Saf 2011;20:1052-56. http:// dx.doi. org/10. 1136/ bmjqs. 2010. 050856.
  33. Sahlström M, Partanen P, Azimirad M, Selander T, Turunen H. Patient participation in patient safety-An exploration of promoting factors. J Nurs Manag 2019;27(1):84-92. doi: 10.1111/jonm.12651.


 

Journal of Patient Safety & Quality Improvement
Volume 8, Issue 1
January 2020
Pages 53-63

Files

Share

How to cite

Statistics