Expert Consensus on Currently Accepted Measures of Harm

Area of Science:

• Health Services Research
• Patient Safety
• Medical Quality Improvement

Background:

• The landscape of healthcare-associated harm has evolved significantly since the Harvard Medical Practice Study.
• Contemporary adverse event identification requires updated measures and triggers.
• Existing methods for tracking patient harm need refinement.

Purpose of the Study:

• To generate a contemporary list of triggers and adverse event measures for chart review.
• To determine the current incidence of inpatient and outpatient adverse events.
• To establish expert consensus on the clinical importance and suitability of these measures.

Main Methods:

• A modified World Café event was conducted in March 2018.
• Seventy-one content experts from diverse institutions participated.
• Experts rated literature-based triggers and measures on clinical importance and suitability for chart review and electronic extraction.

Main Results:

• 67% of measures and 46% of triggers were deemed highly clinically important.
• 218 triggers/measures were highly amenable to chart review.
• 198 triggers/measures were suitable for electronic surveillance.

Conclusions:

• The World Café method successfully prioritized clinically important measures and triggers.
• Prioritized measures are suitable for chart review, the current gold standard.
• Future validation using electronic surveillance is planned to reduce reliance on chart review.