Study objective

The Emergency Department Trigger Tool (EDTT) is a novel approach to adverse event detection in the ED. We previously described the derivation, validation, and high-level performance of this tool. Here we further detail adverse events detected to demonstrate the utility of the EDTT and how it might be used for quality improvement.

Methods

This is a secondary analysis of data from a retrospective observational study. We ran the EDTT (a computerized query for triggers) on 13 months of ED visit data, reviewing 5,582 selected records using a typical 2-tiered trigger tool approach. The adverse events detected were categorized by place of occurrence (in the ED versus present on arrival), severity, omission/commission, and type using a taxonomy with categories, subcategories, and up to 3 cross-cutting modifiers. We present adverse event data in detail, focusing in turn on each of these descriptors (severity, event types, and cross-cutting themes) and highlight opportunities identified for targeted improvement.

Results

We identified 458 adverse events occurring in the ED for a 13-month period, 10% of which required urgent intervention. Nearly all (90%) were acts of commission. Events resulting in harm were most often related to medications administered and patient care. Common cross-cutting event types included adverse events related to bleeding, opioids, and the use of propofol. Most adverse events (80%) led to temporary harm.

Conclusion

The EDTT identifies a broad spectrum of adverse event types, allowing a review by severity, frequency, and type to better understand existing levels of harm in the ED and identify targets for quality improvement. A multicenter study of the EDTT is currently underway, which will contribute additional power and assess generalizability.

中文翻译：

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使用急诊科触发工具检测急诊科不良事件

学习目标

急诊科触发工具 (EDTT) 是一种在 ED 中检测不良事件的新方法。我们之前描述了该工具的推导、验证和高级性能。在这里，我们进一步详细说明检测到的不良事件，以证明 EDTT 的实用性以及它如何用于质量改进。

方法

这是对回顾性观察研究数据的二次分析。我们对 13 个月的急诊就诊数据运行了 EDTT（触发器的计算机化查询），使用典型的 2 层触发器工具方法审查了 5,582 条选定的记录。检测到的不良事件按发生地点（在急诊室与到达时出现）、严重程度、遗漏/委托和类型进行分类，使用具有类别、子类别和最多 3 个交叉修饰符的分类法。我们详细介绍了不良事件数据，依次关注每个描述符（严重性、事件类型和交叉主题），并强调为有针对性的改进确定的机会。

结果

我们确定了 458 起在 13 个月内发生在急诊室的不良事件，其中 10% 需要紧急干预。几乎所有 (90%) 都是委托行为。导致伤害的事件通常与药物治疗和患者护理有关。常见的交叉事件类型包括与出血、阿片类药物和异丙酚使用相关的不良事件。大多数不良事件 (80%) 导致暂时性伤害。

结论

EDTT 确定了广泛的不良事件类型，允许按严重程度、频率和类型进行审查，以更好地了解 ED 中现有的危害水平并确定质量改进目标。目前正在进行一项关于 EDTT 的多中心研究，这将有助于增加效力并评估普遍性。