Department of Pulmonary Medicine and Infectious diseases, Hilleroed Hospital, Hilleroed, Denmark.
BMJ Open. 2012 Oct 12;2(5). doi: 10.1136/bmjopen-2012-001324. Print 2012.
To describe experiences with the implementation of global trigger tool (GTT) reviews in five Danish hospitals and to suggest ways to improve the performance of GTT review teams.
Retrospective observational study.
The measurement and monitoring of harms are crucial to campaigns to improve the safety of patients. Increasingly, teams use the GTT to review patient records and measure harms in English and non-English-speaking countries. Meanwhile, it is not clear as to how the method performs in such diverse settings.
Review teams from five Danish pilot hospitals of the national Danish Safer Hospital Programme.
We collected harm rates, background and anecdotal information and reported patient safety incidents (PSIs) from five pilot hospitals currently participating in the Danish Safer Hospital Programme. Experienced reviewers categorised harms by type. We plotted harm rates as run-charts and applied rules for the detection of patterns of non-random variation.
The hospitals differed in size but had similar patient populations and activity. PSIs varied between 3 and 12 per 1000 patient-days. The average harm rate for all hospitals was 60 per 1000 patient-days ranging from 34 to 84. The percentage of harmed patients was 25 and ranged from 18 to 33. Overall, 96% of harms were temporary. Infections, pressure ulcers procedure-related and gastrointestinal problems were common. Teams reported differences in training and review procedures such as the role of the secondary reviewer.
We found substantial variation in harm rates. Differences in training, review procedures and documentation in patient records probably contributed to these variations. Training reviewers as teams, specifying the roles of the different reviewers, training records and a database for findings of reviews may improve the application of the GTT.
描述在丹麦的五家医院实施全球触发工具（GTT）审查的经验，并提出改进 GTT 审查团队绩效的方法。
回顾性观察研究。
测量和监测危害对于提高患者安全的运动至关重要。越来越多的团队使用 GTT 来审查患者记录并衡量英语和非英语国家的危害。与此同时，对于该方法在如此多样化的环境中的表现，目前还不清楚。
来自丹麦国家更安全医院计划的五家丹麦试点医院的审查团队。
我们收集了五个试点医院目前参与丹麦更安全医院计划的危害率、背景和轶事信息，并报告了患者安全事件（PSIs）。有经验的审查员根据类型对危害进行分类。我们将危害率绘制成运行图表，并应用了用于检测非随机变异模式的规则。
医院的规模不同，但患者人群和活动相似。PSIs 介于每 1000 个患者日 3 至 12 个之间。所有医院的平均伤害率为每 1000 个患者日 60 个，范围为 34 至 84。受伤害患者的比例为 25%，范围为 18%至 33%。总体而言，96%的伤害是暂时的。感染、压疮、与手术相关的和胃肠道问题很常见。团队报告了培训和审查程序方面的差异，例如二级审查员的角色。
我们发现伤害率存在很大差异。培训、审查程序和患者记录中的文档差异可能导致了这些差异。对审查员进行团队培训、明确不同审查员的角色、培训记录以及审查结果数据库可能会提高 GTT 的应用。
