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

We previously developed and validated the Emergency Department Trigger Tool (EDTT) for detection of adverse events, featuring an automated screen for evidence-based triggers and high-yield sampling. We now report on a recently completed multicenter study of the EDTT, performance of the tool, event types detected, and site differences.

This retrospective, observational study used 18 months of data at 3 sites (452,719 records screened; 187,345 with more than or equal to 1 trigger). We performed 2-tiered dual independent review of a sample of 8,996 records (∼3,000 per site), selected from a balanced set of records, based on trigger count per record. We characterized adverse events identified by occurrence (emergency department [ED] or present on arrival), severity, and type, focusing here specifically on ED adverse events.

In reviews of 8,996 records, we found 5,473 adverse events in 3,983 unique visits (yield: 44.3% of visits), including 2,359 ED adverse events and 3,114 present on arrival adverse events, with an ED adverse event rate of 0.26 per visit reviewed. ED adverse event yields using the EDTT were similar across sites (22.8%, 18.4%, 22.1%). Individual trigger performance was largely similar across sites and the EDTT performed well in detecting adverse events (area under the curve 78% across sites, range: 77% to 78%). Medication and patient-care related categories comprised the majority (81%) of ED adverse events, with some site differences.

The EDTT provides a robust approach for ED quality and safety review with performance in detecting ED adverse events that surpasses traditional approaches and demonstrates generalizability across academic centers. Results are consistent with those obtained in our previous single-center study and are now replicated in multiple sites using a different electronic medical record system and reviewers.