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Development and validation of trigger tool for multimorbid patients (MUltimorbid Patients-Estonian Trigger Tool). A
Angela Kannukene1,2, Carola Orrego3,4, Margus Lember1,2
1Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Background:
Adverse events in healthcare are common due to complexity of care. Multimorbid patients may be at higher risk because multiple chronic diseases and medications can affect and interfere with each other and the treatment. We describe the development and validation process of a novel trigger tool for evaluating adverse events in hospitalized multimorbid patients.
Methods:
This is a mixed-methods study. We used literature review to collect triggers, removed irrelevant triggers according to face validity, translated the triggers to Estonian with two translators and chose the best translation, and selected the triggers for preliminary tool with an expert panel. A pilot study was conducted on using both trigger tool and manual chart review on the same charts for validation. Corrections were made to the trigger tool. Final validation was conducted with the trigger tool and a manual review on the same 90 charts as a reference standard.
Results:
After literature review, translations and expert panels the preliminary tool had 62 triggers. After piloting on 88 charts, 21 triggers were removed. For validation, we used manual chart review on the same charts as a reference standard. The final trigger tool has 41 triggers and against reference standard it showed sensitivity of 0.61, specificity of 0.85, positive predictive value of 0.79, and negative predictive value of 0.70. With the trigger tool, 61% of the charts had at least one trigger and the prevalence of charts with adverse events was 38%. The length of stay was significantly higher with patients who experienced an adverse event.
Conclusion:
We introduce a novel validated trigger tool for multimorbid hospitalized patients. This study explains the development and validation of the trigger. We recommend this tool for measuring adverse events in hospitalized multimorbid patients. The preliminary results indicate that this population may have higher prevalence of adverse events than previously reported in general inpatient populations.
Insights
A new trigger tool effectively identifies adverse events in hospitalized patients with multiple chronic conditions. This validated tool shows promising results for measuring patient safety and may indicate a higher prevalence of adverse events in this population.
Area of Science:
- Healthcare quality improvement
- Patient safety research
- Clinical informatics
Background:
- Healthcare complexity contributes to frequent adverse events.
- Multimorbid patients face elevated risks due to interacting diseases and medications.
- A novel trigger tool was developed and validated for hospitalized multimorbid patients.
Purpose of the Study:
- To develop and validate a novel trigger tool for identifying adverse events in hospitalized multimorbid patients.
- To assess the tool's performance against a reference standard.
Main Methods:
- Mixed-methods approach including literature review, expert panel review, and translation.
- Pilot study for initial validation and refinement of the trigger tool.
- Final validation using the trigger tool against manual chart review on 90 charts.
Main Results:
- The final trigger tool comprises 41 triggers.
- Validation demonstrated sensitivity of 0.61, specificity of 0.85, PPV of 0.79, and NPV of 0.70.
- 38% of charts indicated adverse events, with a higher length of stay for affected patients.
Conclusions:
- A novel, validated trigger tool for adverse event detection in hospitalized multimorbid patients has been developed.
- The tool is recommended for measuring adverse events in this specific patient group.
- Preliminary findings suggest a potentially higher prevalence of adverse events in multimorbid inpatients than previously reported.
