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Validation of triggers and development of a pediatric trigger tool to identify adverse events

Maria Unbeck1,2, Synnöve Lindemalm3,4, Per Nydert5,6

  • 1Department of Orthopedics, Danderyd Hospital, 182 88, Stockholm, Sweden. maria.unbeck@ds.se.

BMC Health Services Research
|December 22, 2014
PubMed

Insights

Adverse events (AEs) are common in hospitalized children and most are preventable. A new pediatric trigger tool helps identify and analyze these AEs to improve patient safety.

Area of Science:

  • Pediatric Patient Safety
  • Healthcare Quality Improvement
  • Medical Record Review Methodologies

Background:

  • Limited understanding of adverse events (AEs) in pediatric populations.
  • Existing record review tools for AE identification in pediatrics lack comprehensive focus.
  • Need for a broadly applicable tool to detect AEs in hospitalized children.

Purpose of the Study:

  • To develop a broadly applicable record review tool for identifying AEs in pediatric inpatients.
  • To adapt and refine trigger definitions and incorporate AE preventability decision support.
  • To introduce novel triggers specific to pediatric care across various clinical specialties.

Main Methods:

  • Development of a pediatric trigger tool using literature review and a modified Delphi process.
  • The tool initially comprised 88 triggers with definitions and preventability decision support.
  • Retrospective review of 600 hospitalized pediatric patient records by nurse-physician teams across different units.

Main Results:

  • The initial tool identified potential AEs in 296 of 600 records.
  • Physician review confirmed 563 AEs in 204 patients (34.0%), with 442 preventable AEs in 161 patients (26.8%).
  • The final refined tool, after a second Delphi round, required 29 triggers with an overall positive predictive value of 22.9%.

Conclusions:

  • Adverse events are frequent in pediatric inpatients and a significant proportion are preventable.
  • The developed pediatric trigger tool, including preventability assessment, is effective in identifying AEs.
  • This tool can aid healthcare organizations in measuring and analyzing AEs to enhance patient safety for hospitalized children.
Abstract

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