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A Customized Triggers Program: A Children's Hospital's Experience in Improving Trigger Usability
Insights
Children's National Hospital enhanced patient safety by developing a customized pediatric triggers program. This program significantly increased the clinical utility of safety event detection, improving real-time patient care.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety Research
- Pediatric Healthcare Innovation
Background:
- Patient safety programs are crucial in the US, yet errors persist.
- Traditional voluntary reporting systems have limitations in preventing patient harm.
- Novel tools like trigger programs offer opportunities to enhance patient safety.
Purpose of the Study:
- To implement and evaluate a customized pediatric triggers program at Children's National Hospital.
- To improve the clinical utility of safety event detection using a "trigger signal" metric.
- To increase the overall trigger signal from 8% to 16% within 12 months.
Main Methods:
- Developed a pediatric triggers program with near real-time reporting of potential safety events.
- Defined "trigger signal" as the percentage of true adverse or near-miss events per total triggers.
- Utilized a key driver diagram focusing on program structure, data analytics, awareness, and engagement.
Main Results:
- The trigger signal increased from 8% to 41% and was sustained, even during the COVID-19 pandemic.
- Key interventions included restructuring the program, enhancing stakeholder engagement, and creating self-service reports.
- The time to implement new triggers decreased, indicating improved efficiency.
Conclusions:
- The customized triggers program demonstrated successful evolution and increased clinical utility.
- This iterative approach can be implemented by hospitals to improve real-time patient care.
- A customized, iterative strategy is more effective than a static, one-size-fits-all model for patient safety.
Background:
Despite the growth of patient safety programs across the United States, errors and adverse events remain a source of patient harm. Many hospitals rely on retrospective voluntary reporting systems; however, there are opportunities to improve patient safety using novel tools like trigger programs.
Methods:
Children's National Hospital developed a unique pediatric triggers program that offers customized, near real-time reports of potential safety events. Our team defined a measure to quantify clinical utility of triggers, termed "trigger signal," as the percentage of cases that represent true adverse or near-miss events (numerator) per total triggers activated (denominator). Our key driver diagram focused on unifying the program structure, increasing data analytics, promoting organizational awareness, and supporting multidisciplinary end user engagement. Using the model for improvement, we aimed to double overall trigger signal from 8% to 16% and sustain for 12 months.
Results:
The trigger signal increased from 8% to 41% and sustained during the coronavirus disease 2019 pandemic. A balancing measure of time to implement a new trigger decreased. Key interventions to increase trigger signal were change in the program structure, increasing stakeholder engagement, and development of self-service reports for end users.
Conclusions:
Children's National Hospital's triggers program highlights successful evolution of an iterative, customized approach to increase clinical utility that hospitals can implement to impact real-time patient care. This triggers program requires an iterative, customized approach rather than a "1-size-fits-all," static paradigm to add a new dimension to current patient safety programs.
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