ArticleBMJ quality & safety2018
An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.
Article in BMJ quality & safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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The trial behind it
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Comparing rates of adverse events detected in incident reporting and the Global Trigger Tool: a systematic review.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2023Pooled it
- Preventable medication harm across health care settings: a systematic review and meta-analysis.BMC medicine · 2020Pooled it
- Wrong-side imaging orders: automated detection using electronic health record data - a retrospective cohort study.BMJ open quality · 2026Article
- Development and implementation of a quality improvement framework for the prevention hospital-onset bacteremia and fungemia.Infection control and hospital epidemiology · 2026Article
- A digital quality measure for emergency presentation of pancreatic cancer.British journal of cancer · 2026Article
- Identifying diagnostic errors in the emergency department using trigger-based strategies.BMJ open quality · 2025Observational
- Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Article
- "I Had No Idea This Happened": Electronic Feedback on Clinical Reasoning for Hospitalists.Journal of general internal medicine · 2024Article
- Patient-Clinician Diagnostic Concordance upon Hospital Admission.Applied clinical informatics · 2024Article
- Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care.JAMA internal medicine · 2024Article
- Active monitoring of antifungal adverse events in hospitalized patients based on Global Trigger Tool method.Frontiers in pharmacology · 2024Article
- Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients.Biomolecules & biomedicine · 2023Observational
- [Development of clinical risk management in German hospitals].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2022Review
- Developing Health Care Organizations That Pursue Learning and Exploration of Diagnostic Excellence: An Action Plan.Academic medicine : journal of the Association of American Medical Colleges · 2020Article
- A Computational Adverse Event Detection Matrix.Studies in health technology and informatics · 2020Article
- Association between cancer-specific adverse event triggers and mortality: A validation study.Cancer medicine · 2020Article
- Preventing Diagnostic Errors in Ambulatory Care: An Electronic Notification Tool for Incomplete Radiology Tests.Applied clinical informatics · 2020Article
- Developing a cancer-specific trigger tool to identify treatment-related adverse events using administrative data.Cancer medicine · 2020Article
- Application of electronic trigger tools to identify targets for improving diagnostic safety.BMJ quality & safety · 2019Article
- Electronic surveillance of patient safety events using natural language processing.Health informatics journalArticle
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundMethods to identify preventable adverse events typically have low yield and efficiency. We refined the methods of Institute of Healthcare Improvement's Global Trigger Tool (GTT) application and leveraged electronic health record (EHR) data to improve detection of preventable adverse events, including diagnostic errors.
methodsWe queried the EHR data repository of a large health system to identify an 'index hospitalization' associated with care escalation (defined as transfer to the intensive care unit (ICU) or initiation of rapid response team (RRT) within 15 days of admission) between March 2010 and August 2015. To enrich the record review sample with unexpected events, we used EHR clinical data to modify the GTT algorithm and limited eligible patients to those at
resultsOf 88 428 hospitalisations, 887 were associated with care escalation (712 ICU transfers and 175 RRTs), of which 92 were flagged as trigger-positive and reviewed. Preventable adverse events were detected in 41 cases, yielding a trigger positive predictive value of 44.6% (reviewer agreement 79.35%; Cohen's kappa 0.573). We identified 7 (7.6%) diagnostic errors and 34 (37.0%) care management-related events: 24 (26.1%) adverse drug events, 4 (4.3%) patient falls, 4 (4.3%) procedure-related complications and 2 (2.2%) hospital-associated infections. In most events (73.1%), there was potential for temporary harm.
conclusionWe developed an approach using an EHR data-based trigger and modified review process to efficiently identify hospitalised patients with preventable adverse events, including diagnostic errors. Such e-triggers can help overcome limitations of currently available methods to detect preventable harm in hospitalised patients.
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