Division of Hospital Medicine, Medical Director of Clinical Decision Support, Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Pediatrics. 2012 Nov;130(5):e1206-14. doi: 10.1542/peds.2012-0179. Epub 2012 Oct 8.
To evaluate and characterize the Global Trigger Tool's (GTT's) utility in a pediatric population; to measure the rate of harm at our institution and compare it with previously established trigger tools and benchmark rates; and to describe the distribution of harm of the detected events.
Per the GTT methodology, 240 random inpatient charts were retrospectively reviewed over a 12-month pilot period for the presence of 53 predefined safety triggers. When triggers were detected, the reviewers investigated the chart more thoroughly to decide whether an adverse event occurred. Agreement with a physician reviewer was then reached, and a level of harm was assigned.
A total of 404 triggers were detected (1.7 triggers per patient), and 88 adverse events were identified. Rates of 36.7 adverse events per 100 admissions and 76.3 adverse events per 1000 patient-days were calculated. Sixty-two patients (25.8%) had at least 1 adverse event during their hospitalization, and 18 (7.5%) had >1 event identified. Three-quarters of the events were category E (temporary harm). Two events required intervention to sustain life (category H). Two of the 6 trigger modules identified 95% of the adverse events.
The GTT demonstrated utility in the pediatric inpatient setting. With the use of the trigger tool, we identified a rate of harm 2 to 3 times higher than previously published pediatric rates. Modifications to the trigger tool to address pediatric-specific issues could increase the test characteristics of the tool.
评估和描述全球触发工具（Global Trigger Tool，GTT）在儿科人群中的实用性；测量本机构的伤害发生率，并与先前建立的触发工具和基准率进行比较；描述已检测到的事件伤害分布情况。
根据 GTT 方法，在为期 12 个月的试点期间，回顾性地对 240 份随机住院病历进行了审查，以查找 53 个预先确定的安全触发因素。当发现触发因素时，审查员会更深入地检查病历，以确定是否发生不良事件。然后与一名医师审查员达成一致，并确定伤害级别。
共发现 404 个触发因素（每个患者 1.7 个），确定了 88 个不良事件。计算出每 100 例住院患者中有 36.7 例不良事件和每 1000 例患者中有 76.3 例不良事件的发生率。62 名患者（25.8%）在住院期间至少发生了 1 次不良事件，18 名患者（7.5%）发生了 >1 次事件。事件的四分之三为 E 类（暂时伤害）。有 2 个事件需要干预以维持生命（H 类）。6 个触发模块中的 2 个模块识别出了 95%的不良事件。
GTT 在儿科住院环境中具有实用性。使用触发工具，我们确定的伤害发生率比以前发表的儿科发生率高 2 至 3 倍。对触发工具进行修改以解决儿科特定问题可以提高工具的测试特性。
