View source for Identifying Previously Undetected Harm: Piloting the Institute for Healthcare Improvement's Global Trigger Tool in the Veterans Health Administration

This is a review of the 2015 article "Identifying Previously Undetected Harm: Piloting the Institute for Healthcare Improvement's Global Trigger Tool in the Veterans Health Administration" by Mull et al.<ref name="GTT"> http://www.ncbi.nlm.nih.gov/pubmed/?term=Identifying+Previously+Undetected+Harm%3A+Piloting+the+Institute+for+Healthcare+Improvement%E2%80%99s+Global Mull HJ, Brennan CW, Folkes T, Hermos J, Chan J, Rosen AK, Simon SR.Identifying Previously Undetected Harm: Piloting the Institute for Healthcare Improvement's Global Trigger Tool in the Veterans Health Administration. Qual Manag Health Care. 2015 Jul-Sep;24(3):140-6. doi: 10.1097/QMH.0000000000000060.</ref>

== Introduction ==
Adverse Event (AE) detection is an essential component of organizational patient safety programs, but at the moment, most organizations use resource-intensive and unreliable methods to detect these errors, such as random chart reviews or voluntary incident reporting. The Institute for Healthcare Improvement (IHI) developed a set of algorithms for different AEs and have a specific protocol for confirmatory chart review (using the [[EHR]]) that is much less time and resource-intensive than traditional random chart review protocols. So far, this process has been found to be better at determining "true positive" adverse events than many other methods. 

This study proposes to assess the effectiveness of the Institute for Healthcare Improvement’s [[Global trigger tool|Global Trigger Tool (GTT)]] in a VA facility by examining the overlap of AE detection between GTT and existing surveillance measures.

== Methods ==

The VA facility adapted the existing GTT methodology slightly, but roughly, "the IHI GTT process imposes a 20-minute time limit in which a trained reviewer, typically a nurse, records whether any of 52 triggers are evident. Trigger-flagged cases then undergo a second round of review by a physician to confirm the event and assign a rating of degree of harm using a validated harm scale. The second review may take as little as 2–5 minutes."<ref name="GTT"></ref> For this study, the population included medical/surgical hospitalizations at one large VA facility with a discharge between July 1 and October 27, 2012. 

 
Possible Adverse Events (trigger examples): 
(e.g.: blood or blood product; device or medical-surgical supply, including health information technology; fall; HAI; medication or other substance; pressure ulcer; surgery or anesthesia; and venous thromboembolism) 

== Results ==
109 AEs identified using GTT methodology

88% of identified AEs were not detected by the existing surveillance measures such as VA Surgical Quality Program (VASQIP) or Patient Safety Quality Indicators (PSIs)

60% the AEs identified resulted in minor harm 

== Discussion ==

This study corroborates with studies done in the private sector that showed the GTT is helpful in identifying AEs that are often not detected via other methods (or are detected with greater efficiency and less cost than those other methods). The authors of this study hope that its success will influence the VA to take steps to implement the GTT widely, across all institutions.

== Comments ==
This study is another example of the importance of using EHRs and the data they collect to further the improvement of patient safety in organizations. It is so important to use HIT to its potential and to do so in the most efficient and cost effective ways.

== Related Articles ==

[[Electronic health record-based triggers to detect potential delays in cancer diagnosis]]

[[Electronic health record-based surveillance of diagnostic errors in primary care]]

[[Department of Veterans Affairs Initiatives]]

[[Global trigger tool]]

== References ==
<references/>

[[Category:Reviews]]
[[Category:EHR]]
[[Category: HI5313-2015-FALL]]