Variation in detected adverse events using trigger tools: A systematic review and meta-analysis

Adverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely.; This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence.; Systematic review and meta-analysis.; To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review.; Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9-37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4-164.7. Overall studies' risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation.; Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation

Patient Safety in Orthopedics and Traumatology

Surgical specialties have a higher risk of errors and adverse events as represented in literature Orthopedics is one such specialty in which the clinical risk is more conspicuous and, consequently, it has a high exposure to medical-legal disputes . The aim of this work is to analyze the clinical risk and alleged malpractice in medical practice, in order to map professional risk and identify recurrent pitfalls

Evaluation of retrospective patient record review as a method to identify patient safety and quality information in orthopaedic care [Elektronisk resurs]

The great benefits of modern healthcare must be weighed against the risk of patient injury due to human intervention. Studies show that adverse events (AE) are identified in up to 16.6% of all hospitalisations. As a step toward preventing AEs, efforts are made to collect patient safety information at different levels in the healthcare systems. The information is neither effectively organised nor integrated within the healthcare systems, leading to difficulty achieving systematic analysis. This may be due to the use of different methods that yield qualitatively different information about AE. The general aim of this thesis was to evaluate the capability of retrospective record review (RRR) methods to identify patient safety and quality information in orthopaedic care. In papers I and II, 395 patient records were retrospectively examined for AEs using both traditional incident reporting methods and RRR for the same cohort. More AEs were identified using RRR than by using traditional incident reporting methods. Also, paper II showed that more AEs were due to deficiencies in care processes rather than to deficiencies in technical skills. In paper III, the efficiency of an orthopaedic nursing improvement initiative, called “improvement theme months,” was evaluated using case study methodology and a RRR of 2,281 patients. Results showed significant improvement over time in performance of risk assessment for pressure ulcers and lowered pressure ulcer prevalence. We found RRR easy to use and valuable as a method to assess improvement over time. In paper IV, the RRR methods, Harvard Medical Practice Study (HMPS) and Global Trigger Tool (GTT) were compared for capability to identify AEs in a sample of 350 randomly selected orthopaedic admissions. Results showed that HMPS identified more AEs than GTT did. The overall positive predictive value (PPV) was 40% and 30% for HMPS and GTT methods, respectively. Retrospective record review appears to achieve wider coverage when identifying orthopaedic AEs at a local level. Given that many current methods vary considerably in quality of data gathered and in coverage, which require multiple methods to be used concurrently, the wider coverage characteristic of RRR is an advantage. Consequently, RRR could play a vital role in quality and safety information systems in order to identify, categorise, and analyse quality and patient safety problems and to provide the basis for interventions. Increased awareness, consideration of risk factors, interventions focused on multidisciplinary and interdepartmental teamwork, and strategies that focus on healthcare processes may reduce the frequency of AEs in orthopaedic care. Also, RRR can incorporate a time series display of patient safety intervention outcomes to drive change. As a method, improvement theme months may serve to organise quality and lead to safety improvement in nursing. However, we found that it was associated with a lengthy period of time before new guidelines, quality indicators, and safety initiatives were noticed and became widely used in clinical practice. To achieve sustainable and significant improvement, interventions on many levels of the organisation were needed