Describing adverse events in medical inpatients using the Global Trigger Tool

The purpose of the study was to describe the type, prevalence, severity and preventability of adverse events (AEs) that affected hospitalised medical patients. We used the previously developed and validated Global Trigger Tool from the Institute for Healthcare Improvement.

Using an adapted version of the Global Trigger Tool, we conducted a retrospective chart review of adult patients hospitalised in five medical wards at a university hospital in Switzerland. We reviewed a random sample of 20 patients’ charts for a total study period of 12 months (September 2016 to August 2017). Two trained nurses searched independently for triggers and possible AEs. All AEs were further validated by a senior physician. The number of triggers and AEs detected, as well as the severity and preventability of each, was assessed and analysed using descriptive statistics.

From a sample of 240 patient charts, we identified 1371 triggers and 336 AEs in 144 (60%) inpatients. This translates to an AE rate of 95.7 AEs per 1000 patient days. Most AEs (86.1%) caused temporary harm to the patient and required an intervention and/or prolonged hospitalisation. The estimated preventability of the in-hospital AEs was 29%. Healthcare-associated infections (25.8%) and neurological reactions (22.9%) were the most frequent AE types.

We found that about two thirds of patients suffered from AEs with harm during hospitalisation. It is common knowledge that AEs occur in hospitals and that they have potentially harmful consequences for patients, as well as a strong economic impact. However, to adequately prioritise patient safety interventions, it is essential to explore the nature, prevalence, severity and preventability of AEs. This is not only beneficial for the patients, but also cost effective in terms of shorter hospital stays.