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A Trigger Tool to Identify Adverse Events in the Intensive Care Unit

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Background: The Institute for Healthcare Improvement has tested and taught use of a variety of trigger tools, including those for adverse medication events, neonatal intensive care events, and a global trigger tool for measuring all event categories in a hospital. The trigger tools have evolved as a complimentary adjunct to voluntary reporting. The Trigger Tool technique was used to identify the rate of occurrence of adverse events in the intensive care unit (ICU), and a subset of ICUs described those events in detail.

Methods: Sixty-two ICUs in 54 hospitals (both academic and community) engaged in IHI critical care collaboratives between 2001 and late 2004. Charts were selected using a random sampling technique and reviewed using a two-stage process.

Results: The prevalence of adverse events observed on 12,074 ICU admissions was 11.3 adverse events/100 patient days. For a subset of 1,294 charts from 13 ICUs which were reviewed in detail, 1,450 adverse events were identified, for a prevalence of 16.4 events/100 ICU days. Fifty-five percent of the charts in this subset contained at least one adverse event.

Discussion: The Trigger Tool methodology is a practical approach to enhance detection of adverse events in ICU patients. Evaluation of these adverse events can be used to direct resource use for improvement work. The measurement of these sampled chart reviews can also be used to follow the impact of the change strategies on the occurrence of adverse events within a local ICU.

Document Type: Research Article

Publication date: October 1, 2006

More about this publication?
  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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