From the Department of Emergency Medicine and.
Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine.
J Patient Saf. 2019 Mar;15(1):61-68. doi: 10.1097/PTS.0000000000000341.
Little is known about which methods are best for detecting adverse events in the emergency department (ED).
This study compared the ability of trigger tool and reporting methods to capture adverse events in the ED and investigated the characteristics of the adverse events identified by each.
This 1-year prospective observational cohort study evaluated a monitoring system that combined 2 reporting methods and 5 trigger tool methods to capture adverse events in the ED of an academic medical center. Measurement outcomes included the number, type, and physical impact of the captured adverse events.
Among 69,327 adult nontrauma ED visits, 285 adverse events were identified. Of these adverse events, 77.2% were identified using reporting methods, 26% using trigger tool methods, and 3.2% using both methods. Most patients (81.7%) incurred temporary, minor physical impacts. Of the adverse events that occurred, 86.7% were related to clinical performance. Compared with reporting methods, trigger tool methods had a lower positive predictive rate to identify adverse events (odds ratio [OR], 0.1; 95% confidence interval [CI], 0.09-0.16), a greater proportion of adverse events occurring during the preinterventation and postintervention phases (OR, 17.0; 95% CI, 8.48-34.16), and more cases of severe physical impact or death (OR, 5.4; 95% CI, 2.62-11.10).
The reporting methods more effectively captured greater numbers of adverse events, whereas the adverse events captured by the trigger tool methods were more likely to be severe physical impacts. The combined use of the different methods had synergistic benefits for monitoring adverse events in the ED.
对于在急诊科（ED）中哪种方法最适合检测不良事件，人们知之甚少。
本研究比较了触发工具和报告方法在 ED 中捕获不良事件的能力，并研究了每种方法识别的不良事件的特征。
这项为期 1 年的前瞻性观察队列研究评估了一种监测系统，该系统结合了 2 种报告方法和 5 种触发工具方法，以捕获学术医疗中心 ED 中的不良事件。测量结果包括捕获的不良事件的数量、类型和身体影响。
在 69327 例成人非创伤性 ED 就诊中，发现 285 例不良事件。在这些不良事件中，77.2%通过报告方法识别，26%通过触发工具方法识别，3.2%通过两种方法识别。大多数患者（81.7%）遭受暂时的轻微身体影响。发生的不良事件中，86.7%与临床表现有关。与报告方法相比，触发工具方法识别不良事件的阳性预测率较低（比值比 [OR]，0.1；95%置信区间 [CI]，0.09-0.16），更多不良事件发生在干预前和干预后阶段（OR，17.0；95% CI，8.48-34.16），更严重的身体影响或死亡病例（OR，5.4；95% CI，2.62-11.10）。
报告方法更有效地捕获了更多数量的不良事件，而触发工具方法捕获的不良事件更有可能是严重的身体影响。不同方法的联合使用对监测 ED 中的不良事件具有协同作用。
