Multicenter Trial of the Emergency Department Trigger Tool for Adverse Event Detection

Area of Science:

• Healthcare quality and safety research.
• Clinical informatics and data analysis.
• Emergency medicine and patient outcomes.

Background:

• The Emergency Department Trigger Tool (EDTT) was previously developed and validated for adverse event detection.
• The EDTT features automated screening and high-yield sampling for efficiency.

Purpose of the Study:

• To report on a multicenter study evaluating the EDTT's performance.
• To identify types of adverse events detected by the EDTT.
• To analyze site-specific differences in EDTT performance.

Main Methods:

• A retrospective, observational study using 18 months of data from 3 sites.
• Screened 452,719 records, with 187,345 triggering the tool.
• Performed dual independent review of 8,996 sampled records.

Main Results:

• Found 5,473 adverse events in 3,983 unique visits (44.3% yield).
• ED adverse event rate was 0.26 per visit reviewed.
• EDTT performance was consistent across sites (AUC 78%), with medication and patient-care events being most common.

Conclusions:

• The EDTT offers a robust approach for emergency department quality and safety reviews.
• EDTT performance in detecting adverse events surpasses traditional methods.
• The tool demonstrates generalizability across academic centers and different electronic medical record systems.