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A trigger tool fails to identify serious errors and adverse events in pediatric otolaryngology
Lina Lander1, David W Roberson, Katrina M Plummer
1Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. llander@unmc.edu
Insights
A trigger tool effectively identified documentation errors in pediatric otolaryngology but missed complex adverse events. A hybrid chart review approach may be more cost-effective for quality improvement.
Area of Science:
- Quality Improvement
- Patient Safety
- Pediatric Otolaryngology
Background:
- Adverse events and errors occur in pediatric otolaryngology services.
- Accurate identification is crucial for quality improvement initiatives.
Purpose of the Study:
- To develop and validate a trigger tool for identifying errors and adverse events.
- To quantify the types and frequency of these events in pediatric otolaryngology.
Main Methods:
- Retrospective chart review of 50 inpatient admissions.
- Utilized a validated trigger tool and compared findings to a gold standard chart review by otolaryngologists.
Main Results:
- Errors and adverse events were present in all reviewed admissions.
- The trigger tool demonstrated high reliability for medication and medical record triggers (kappa=0.90, 0.61).
- 93% of identified events were documentation-related; only 3% were potentially harmful.
Conclusions:
- The trigger tool successfully identified clerical and administrative errors but not complex adverse events.
- A hybrid chart review approach may offer a cost-effective solution for pediatric otolaryngology quality improvement.
Objective:
To identify and quantify errors and adverse events on an inpatient academic tertiary-care pediatric otolaryngology service, a trigger tool was developed and validated as part of a quality improvement initiative.
Study Design:
Retrospective record review.
Setting:
Children's Hospital Boston quality improvement initiative.
Subjects And Methods:
Fifty inpatient admissions were reviewed. The gold standard for errors and adverse events identification was a detailed chart review by two board-certified otolaryngologists blinded to trigger tool findings.
Results:
Trigger tool interrater reliability ranged from poor to high for admission triggers (kappa = 0.35, 95% confidence interval [95% CI] -0.07 to 0.76), discharge triggers (kappa = 0.63, 95% CI 0.27-0.99), medical records triggers (kappa = 0.61, 95% CI 0.11-1.00), and medication triggers (kappa = 0.90, 95% CI 0.71-1.00). Errors and adverse events were found in all admissions: three percent were potentially harmful, and 93 percent were documentation-related.
Conclusion:
The trigger tool was successful in identifying clerical and administrative errors and adverse events but failed to identify complex errors and adverse events. A hybrid approach for chart review may be cost-effective in pediatric otolaryngology.
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