That is the conclusion of an April 2011 article in the medical journal Health Affairs. When compared with standard methods of reporting adverse events in hospitals--a hospital's own voluntary reporting system and screening using the Agency for Healthcare Research, and Quality's Patient Safety Indicators--the "Global Trigger Tool" found that approximately 90% of such errors were under-reported.
The Global Trigger Tool uses specific methods
for reviewing medical charts. Closed patient
charts are reviewed by two or three employees--
usually nurses and pharmacists, who are trained
to review the charts in a systematic manner by
looking at discharge codes, discharge summaries,
medications, lab results, operation records,
nursing notes, physician progress notes, and
other notes or comments to determine whether
there is a “trigger” in the chart. A trigger could be
a notation indicating, for example, a medication
stop order, an abnormal lab result, or use of an
antidote medication. Any notation of a trigger
leads to further investigation into whether an
adverse event occurred and how severe the event
was. A physician ultimately has to examine and
sign off on this chart review.In this study's review of 795 patient records from three hospitals, overall adverse events occurred in 33.2% of hospital admissions. This compares with inpatient adverse event rates of approximately 3% in other studies. Given the attention that has been focused on patient safety in the last 10-15 years, especially since the Institute of Medicine's 1999 report To-Err-is-Human: Building a Better Healthcare System, it's disturbing to think that this level of errors still seems to exist. Moreover, as this study's authors note, the true rates of adverse events are likely to be higher still, given the consistent finding that direct observational studies reveal higher rates of such events than retrospective studies because not all adverse events are documented in the patient record.
The Global Trigger Tool uses specific methods
for reviewing medical charts. Closed patient
charts are reviewed by two or three employees--
usually nurses and pharmacists, who are trained
to review the charts in a systematic manner by
looking at discharge codes, discharge summaries,
medications, lab results, operation records,
nursing notes, physician progress notes, and
other notes or comments to determine whether
there is a “trigger” in the chart. A trigger could be
a notation indicating, for example, a medication
stop order, an abnormal lab result, or use of an
antidote medication. Any notation of a trigger
leads to further investigation into whether an
adverse event occurred and how severe the event
was. A physician ultimately has to examine and
sign off on this chart review.In this study's review of 795 patient records from three hospitals, overall adverse events occurred in 33.2% of hospital admissions. This compares with inpatient adverse event rates of approximately 3% in other studies. Given the attention that has been focused on patient safety in the last 10-15 years, especially since the Institute of Medicine's 1999 report To-Err-is-Human: Building a Better Healthcare System, it's disturbing to think that this level of errors still seems to exist. Moreover, as this study's authors note, the true rates of adverse events are likely to be higher still, given the consistent finding that direct observational studies reveal higher rates of such events than retrospective studies because not all adverse events are documented in the patient record.
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