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Trigger tool versus verbal inventory to detect surgical complications
A Visser1, A E Slaman2, C M van Leijen2
1Department of Surgery, Academic Medical Center, University of Amsterdam, H1-213, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. a.visser@amc.nl.
Purpose:
Traditionally, registering complications after surgery is based on voluntary reporting or incident reports. These methods may fail to detect the total number of complications. A trigger tool was developed to detect complications in hospitalized surgical patients. In this diagnostic study, we compared its sensitivity and specificity with the verbal inventory by surgical staff and residents.
Methods:
A set of 31 potential triggers was chosen based on a systematic review and availability in hospital databases. The trigger tool was developed using multivariable regression and Receiver Operating Characteristic (ROC) analyses. A reference standard consisted of 300 patients, 150 with and 150 without complications. Sensitivity and specificity of the trigger tool and verbal inventory were determined.
Results:
The final trigger tool consisted of nine triggers. Sensitivities of the trigger tool and verbal inventory were 70.7 vs. 78.7%, respectively, while specificities were 70.0 vs. 100.0%, respectively. Sensitivity values to detect major complications were 97.2 vs. 80.6%, respectively.
Conclusions:
The proposed customized trigger tool for a university hospital to detect surgical patients with complications appeared as accurate as a verbal inventory and even more accurate to detect major complications.
Insights
A new trigger tool accurately detects surgical complications, performing comparably to verbal inventory methods. It shows higher sensitivity for identifying major complications in hospitalized patients.
Area of Science:
- Medical Informatics
- Surgical Outcomes Research
- Health Services Research
Background:
- Traditional methods for identifying surgical complications rely on voluntary reporting, potentially underestimating their true incidence.
- Incident reports are also used but may not capture all adverse events comprehensively.
- A novel trigger tool was developed to improve the detection of complications in hospitalized surgical patients.
Purpose of the Study:
- To develop and validate a trigger tool for detecting surgical complications.
- To compare the sensitivity and specificity of this trigger tool against a verbal inventory method used by surgical staff and residents.
Main Methods:
- A systematic review identified 31 potential triggers, integrated into a trigger tool using multivariable regression and ROC analyses.
- A reference standard of 300 patients (150 with and 150 without complications) was used for validation.
- Sensitivity and specificity were calculated for both the trigger tool and the verbal inventory.
Main Results:
- The final trigger tool comprised nine triggers.
- The trigger tool demonstrated sensitivities of 70.7% and specificities of 70.0%.
- The verbal inventory had sensitivities of 78.7% and specificities of 100.0%.
- For major complications, the trigger tool's sensitivity was 97.2% compared to 80.6% for the verbal inventory.
Conclusions:
- The customized trigger tool for a university hospital is as accurate as a verbal inventory for detecting surgical complications.
- The trigger tool is more sensitive than the verbal inventory in identifying major complications.
- This tool offers a valuable method for improving surgical complication surveillance.
