Parrinello Vincenzo, Grasso Elena, Saglimbeni Giuseppe, Patanè Gabriella, Scalia Alma, Murolo Giuseppe, Lachman Peter
U.O. Qualità e Rischio Clinico, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele, Catania, 95129, Italy.
Servizio 8 "Qualità, Governo Clinico e Sicurezza del Paziente", Assessorato della Salute, Regione Siciliana, Palermo, 90145, Italy.
F1000Res. 2019 Mar 7;8:263. doi: 10.12688/f1000research.18025.4. eCollection 2019.
The Institute for Healthcare Improvement (IHI) has proposed a new method, the Global Trigger Tool (IHI GTT), to detect and monitor adverse events (AEs) and provide information to implement improvement. In 2015, the Sicilian Health System adopted IHI GTT to assess the number, types and severity levels of AEs. The GTT was implemented in 44 of 73 Sicilian public hospitals and 18,008 clinical records (CRs) were examined. Here we present the standardized application of the GTT and the preliminary results of 14,706 reviews of CRs. IHI GTT was adapted, developed and implemented to the local context. Reviews of CRs were conducted by 199 professionals divided into 71 review teams consisting of three individuals: two of whom had clinical knowledge and expertise, and a physician to authenticate the AE. The reviewers entered data into a dedicated IT-platform. All 44 of the public hospitals were included, with approximately 300,000 yearly inpatient admissions out of a population of approximately 5 million. In total, 14,706 randomized CRs of inpatients from medicine, surgery, obstetric and ICU wards, from June 2015 to June 2018 were reviewed. In 975 (6.6%) CRs at least one AE was found. Approximately 20,000 patients of the 300,000 discharged each year in Sicily have at least one AE. In 5,574 (37.9%) CRs at least one trigger was found. A total of 1,542 AEs were found. The analysis of ROC curve shows that the presence of two triggers in a CR indicates with high probability the presence of an AE. The most frequent type of AE was in-hospital related infection. The GTT is an efficient method to identify AEs and to track improvement of care. The analysis and monitoring of some triggers is important to prevent AEs. However, it is a labor-intensive method, particularly if the CRs are paper-based.
医疗改进研究所（IHI）提出了一种新方法——全球触发工具（IHI GTT），用于检测和监测不良事件（AE）并提供信息以实施改进措施。2015年，西西里岛医疗系统采用IHI GTT来评估不良事件的数量、类型和严重程度。GTT在西西里岛73家公立医院中的44家实施，并检查了18,008份临床记录（CR）。在此，我们展示了GTT的标准化应用以及对14,706份CR审查的初步结果。IHI GTT已根据当地情况进行了调整、开发和实施。对CR的审查由199名专业人员进行，他们被分成71个审查小组，每个小组由三人组成：其中两人具备临床知识和专业技能，还有一名医生对不良事件进行认证。审查人员将数据录入一个专用的信息技术平台。所有44家公立医院都被纳入，在大约500万人口中，每年有大约30万例住院患者。总共审查了2015年6月至2018年6月期间来自内科、外科、产科和重症监护病房的14,706份住院患者随机CR。在975份（6.6%）CR中发现了至少1起不良事件。在西西里岛每年出院的30万患者中，约有20,000名患者至少发生1起不良事件。在5,574份（37.9%）CR中发现了至少1个触发因素。总共发现了1,542起不良事件。ROC曲线分析表明，一份CR中存在两个触发因素很可能表明存在不良事件。最常见的不良事件类型是医院相关感染。GTT是识别不良事件和跟踪护理改进的有效方法。对一些触发因素的分析和监测对于预防不良事件很重要。然而，这是一种劳动密集型方法，特别是如果临床记录是纸质的。
