Hooper A J, Tibballs J
Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria.
Anaesth Intensive Care. 2014 Mar;42(2):199-206. doi: 10.1177/0310057X1404200206.
Reduction of adverse events depends on accurate detection. The utility of a Trigger Tool to detect and classify severity of adverse events in an intensive care unit of a paediatric university hospital was compared to voluntary reporting. Sixty patient records were randomly selected from 314 admissions over three months. Events detected by the Trigger Tool were classified by two independent investigators as insignificant, minor, moderate, major or catastrophic. Examination of each record required, on average, 40 minutes. Ninety-eight adverse events (1.66/patient) were detected in 59 available records. Mean admission was 2.77 days. The incidence of adverse events was 59.9 per 100 patient days or 0.60 events per patient per day. The number of events detected by the Trigger Tool was related to duration of admission (r=0.70, P <0.0001) and risk of mortality on admission (r=0.50, P=0.0001) but not to age. The inter-rater agreement on detection of adverse events was good. Investigator One detected 66 adverse events while Investigator Two detected 93 events (kappa 0.63). Of the 61 events detected by both investigators, the agreement of classification of severity was very good (kappa 0.89). Of the 56 events rated similarly by both investigators, 13 (23%) were insignificant, 19 (34%) were minor, 17 (30%) were moderate, 4 (7%) were major and 3 (6%) were catastrophic. Only four adverse events had been reported voluntarily, of which two were detected using the Trigger Tool. Whereas the Trigger Tool is a simple, efficient and robust method, voluntary reporting is inadequate and captures very few adverse events in the intensive care unit environment.
不良事件的减少取决于准确的检测。将一种触发工具用于检测和分类一所儿科大学医院重症监护病房不良事件的严重程度，并与自愿报告进行比较。从三个月内的314例入院病例中随机选取60份患者记录。由两名独立研究人员将触发工具检测到的事件分类为无意义、轻微、中度、严重或灾难性事件。检查每份记录平均需要40分钟。在59份可用记录中检测到98起不良事件（每例患者1.66起）。平均住院时间为2.77天。不良事件的发生率为每100患者日59.9起或每位患者每天0.60起事件。触发工具检测到的事件数量与住院时间（r=0.70，P<0.0001）和入院时的死亡风险（r=0.50，P=0.0001）相关，但与年龄无关。在不良事件检测方面，评估者间的一致性良好。研究人员一检测到66起不良事件，而研究人员二检测到93起事件（kappa值为0.63）。在两名研究人员都检测到的61起事件中，严重程度分类的一致性非常好（kappa值为0.89）。在两名研究人员评级相似的56起事件中，13起（23%）无意义，19起（34%）轻微，17起（30%）中度，4起（7%）严重，3起（6%）灾难性。只有4起不良事件是自愿报告的，其中2起是使用触发工具检测到的。触发工具是一种简单、高效且可靠的方法，而自愿报告并不充分，在重症监护病房环境中捕获到的不良事件极少。
