Global trigger tool (GTT) of the Institute for Healthcare Improvement (IHI) has been used as a measurement strategy for patient safety by several institutions and national programs. Although the greater ability of the GTT to identify adverse events (AEs) compared to other methods has already been demonstrated, there are few data on its accuracy, and studies suggest lower sensitivity for minor AEs. This study aimed to assess the accuracy of the GTT for identifying AEs in adult inpatients for all AEs and for the subgroup of AEs with greater harm to the patient, classified as F-I on the IHI-GTT adapted version of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index for Categorizing Errors. In this diagnostic test study, GTT is the index test and identification of AEs (yes/no) represents the condition of interest. Due to the lack of a gold standard test, a composite reference standard method was developed. Reference standard method combined real-time (during hospitalizations) and retrospective search of medical records and administrative data for screening criteria and AEs. Both tests were applied to a random sample of 211 hospitalizations of adult inpatients during October-November 2016 in a large public hospital in Belo Horizonte, Brazil. The accuracy of the GTT was evaluated using sensitivity, specificity, and global accuracy. A total of 176 AEs were identified in 67 admissions using reference standard method and 129 AEs in 76 admissions using GTT, resulting in rates of 126 and 93 AEs/1000 patient-days, respectively. Sensitivity, specificity, and global accuracy of the GTT for the identification of individual AEs were, respectively, 0.41 (95% confidence interval [CI] 0.34 ; 0.49), 0.68 (95% CI 0,60 ; 0,74), and 0.54 (95% CI 0,49 ; 0,60) for all AEs, regardless of the harm categorization, and 0.85 (95% CI 0,72 ; 0,93), 0.88 (95% CI 0,82 ; 0,92), and 0.87 (95% CI 0,82 ; 0,91) for the subgroup of AEs categorized as harm F-I. Among the main AEs missed by the GTT are AEs related to nursing care, such as those related to peripheral venous access and gastric/enteric catheters. GTT proved to be a valid method for identifying AEs in adult inpatients. Its accuracy increases when minor harm AEs are not counted. Among the main AEs missed by the GTT are those related to nursing care. Therefore, the GTT should be used in conjunction with other measurement strategies to achieve results that are representative of the quality profile of the care provided and, thus, guide the best improvement strategies.
Commentaire du Dr Marius Laurent (PAQS)
- Les auteurs comparent l’efficacité et la fiabilité du « global trigger tool » pour détecter les événements indésirables (EI) par rapport à une méthode de référence composite, comprenant des interviews sur les lieux des soins, des consultations des résultats d’analyse, des signalements spontanés ou réglementaires, etc., suivis de la revue rétrospective des dossiers en cause. Ils s’intéressent essentiellement au comportement du trigger tool dans les EI catalogués comme sérieux ou graves, où ses performances se rapprochent effectivement de celles de la méthode de référence. Par contre, le trigger tool passe volontiers à côté des événements en lien avec les soins de nursing (sondes gastriques, cathéters périphériques…). La référence décèle 176 EI, le trigger tool 126. 72 EI seulement sont identifiés par les deux méthodes. Nous retombons sur cette conclusion constante : les diverses méthodes de détection ne décèlent pas les mêmes EI, et nous apprenons ici que ces différences dépendent en outre de leur sévérité.
Moraes SM, Ferrari TCA, Beleigoli A.The accuracy of the Global Trigger Tool is higher for the identification of adverse events of greater harm : a diagnostic test study. Int J Qual Health Care 2023;34(1). Doi : 10.1093/intqhc/mzad005.