Variation in detected adverse events using trigger tools: A systematic review and meta-analysis

Area of Science:

• Patient Safety
• Health Services Research
• Medical Informatics

Background:

• Adverse event (AE) detection is critical for patient safety, yet reported incidence rates vary significantly.
• Existing research on AEs has not fully resolved discrepancies in incidence rates across studies.

Purpose of the Study:

• To systematically review and synthesize evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology.
• To investigate whether study characteristics and quality influence reported AE incidence rates.

Main Methods:

• A systematic review and meta-analysis of studies published up to May 2022, querying major databases (PubMed, EMBASE, etc.).
• Inclusion criteria focused on adult inpatients in acute care settings using Trigger Tool methodology, excluding specific study types.
• Risk of bias was assessed, and random regression models were used to analyze variations in AE rates based on nine study characteristics and quality.

Main Results:

• 54 eligible studies, encompassing 194,470 admissions, were included.
• The cumulative AE incidence was 30.0 per 100 admissions, with high heterogeneity (I2 = 99.7%).
• Eight of nine methodological characteristics and study quality were found to explain variations in AE rates.

Conclusions:

• Reported AE incidence rates using trigger tool methodology exhibit significant variation.
• Low reporting standards, particularly regarding the timeframe of AE detection, hinder the explanation of these variations.
• Development of specific reporting guidelines for retrospective medical record review studies is essential to enhance evidence quality.