The emergency department trigger tool: Multicenter trigger query validation.

Area of Science:

• Healthcare quality improvement
• Patient safety research
• Clinical informatics

Background:

• Adverse events (AEs) are a significant concern in healthcare.
• The Emergency Department Trigger Tool (EDTT) was developed for AE detection.
• Previous validation of the EDTT was established.

Purpose of the Study:

• To validate the computerized EDTT screening against manual review as a first step in a multicenter study.
• To establish the automated process for selecting records for AE review.

Main Methods:

• Retrospective observational study of 912 patient visits across three urban academic EDs over 18 months.
• Comparison of automated trigger query results with manual screening by two independent reviewers per site.
• Calculation of positive predictive values (PPVs) and negative predictive values (NPVs) to assess accuracy.

Main Results:

• The EDTT query demonstrated high accuracy with an overall PPV of 95.4% and NPV of 99.2%.
• Individual trigger PPVs exceeded 90% for most triggers across sites.
• Manual review findings were amended in only 1.5% of cases discordant with the automated query.

Conclusions:

• The EDTT trigger query performs effectively compared to manual review.
• Findings demonstrate the feasibility and generalizability of implementing the EDTT query across different sites.
• This validates the EDTT's utility for AE detection and provides a foundation for further research.