Måling af patientskader med IHI Global Trigger Tool Patientsikkert
Måling af patientskader med IHI Global Trigger Tool Lord Kelvin, 1902 © Science Museum/Science & Society pic lib Patientsikkert Sygehus Læringsseminar 5 November 2012 Hvad vil jeg tale om? • Hvad ved vi egentlig om validiteten og metodens karakteristika i øvrigt? • Resultater fra to nye danske studier af reproducerbarheden af GTT Skade Fejl Død Guldstandarden… Metoder til identifikation af skader • OIG-studiet – Tilfældig stikprøve på 278 udskrivelser af Medicarepatienter fra to counties i en uge af august 2008 – To trins-proces: Primær screening efterfulgt af lægeligt review – Fem forskellige screeningmetoder Antal og andel af fundne skader Metode Antal Global Trigger Tool POA-analyse 93 61 Interviews UTH-rapporter PSI-analyse 22 8 8 Andel af de 120 78 % 51 % 18 % 7% 7% Metoder til identifikation af skader • Health Affairs 2011 – Tilfældig stikprøve på 795 udskrivelser fra tre højt specialiserede sygehuse i perioden 1.-31. oktober 2004 – Tre forskellige screeningsmetoder – På ét af sygehusene foretog man lokalt lægeligt review af den komplette journal + øvrige data på samtlige patienter, der indgik Identificerede skader efter alvorlighed E F GTT 204 214 PSI 23 7 UTH 0 2 G H I I alt 8 14 4 354 1 0 4 35 2 0 0 4 Interrater reliability • North Carolina-studiet – 2400 journaler fra patienter udskrevet fra ti tilfældigt udvalgte hospitaler i perioden 1. januar 2002 til 31. december 2007 – Ti journaler pr. kvartal pr. hospital • Mayo-studiet – 1138 indlæggelser fra tre Mayo-campuses i perioden august 2004 til marts 2008 (delvist) 662 HSR: Health Services Research 46:2 (April 2011) Figure 1: Description and Number of Medical Record Reviews, by Reviewer Type (AE, Adverse Event) North Carolina 2400 charts randomly selected from 10 hospitals between 2002 and 2007 teams were frequently identified by the experienced review team as well (high specificity). We did not identify enough adverse events in the more severe categories of G, H, and I to determine with confidence the sensitivity and specificity of the internal and external team reviews for these more severe adverse events (Table 4). North Carolina Figure 4: Level of Agreement between Internal and External Review Teams and the Experienced Review Team Any adverse events Internal External Number of adverse events Adverse event severity 0 Slight 0.2 Fair 0.4 0.6 0.8 1 Moderate Substantial Almost perfect Level of Agreement (Kappa) 1 2 3 4 5 6 7 8 or more Mayo 242 205 156 111 73 46 25 55 211 147 112 65 34 15 14 8 31 58 44 46 39 31 11 47 12.8 28.3 28.2 41.4 53.4 67.4 44.0 85.4 26 35 26 25 14 13 2 15 5 23 18 21 25 18 9 32 Table 3 Agreement between nurse reviewers and between nurse and physician reviewers for identifying adverse events, by site and overall Site Trigger/Adverse events Reviewer pair Simple Kappa coefficient ...................................................................... Coefficient Lower CI Upper CI 0.6312 0.5106 0.7109 0.7290 0.5965 0.7544 0.5777 0.4616 0.6628 0.5291 0.4026 0.7015 0.5804 0.4518 0.6775 0.6488 0.5128 0.7071 0.5034 0.3686 0.6058 0.3886 0.2469 0.6206 0.6820 0.5693 0.7443 0.8092 0.6803 0.8016 0.6520 0.5545 0.7198 0.6696 0.5584 0.7824 ............................................................................................................................................................................. Overall Overall Overall A A A B B B C C C Triggers Adverse Adverse Triggers Adverse Adverse Triggers Adverse Adverse Triggers Adverse Adverse events events events events events events events events RN1 – RN2 RN1 – RN2 RN – MD RN1 – RN2 RN1 – RN2 RN – MD RN1 – RN2 RN1 – RN2 RN – MD RN1 – RN2 RN1 – RN2 RN – MD Table 4 Agreement between nurse reviewers and between nurse and physician reviewers for identifying adverse events, by year Year Trigger/Adverse events Reviewer pair Simple Kappa coefficient Danske erfaringer Downloaded from bmjopen.bmj.com on October 18, 2012 - Published by group.bmj.com Open Access Research Experiences with global trigger tool reviews in five Danish hospitals: an implementation study Christian von Plessen,1 Anne Marie Kodal,2 Jacob Anhøj3 To cite: von Plessen C, Kodal AM, Anhøj J. Experiences with global trigger tool reviews in five Danish hospitals: an implementation study. BMJ Open 2012;2:e001324. ABSTRACT Objectives: To describe experiences with the implementation of global trigger tool (GTT) reviews in five Danish hospitals and to suggest ways to improve the performance of GTT review teams. Design: Retrospective observational study. ARTICLE SUMMARY Article focus ▪ To describe experiences with the implementation of global trigger tool (GTT) reviews in five Danish hospitals. Hvad ved vi så? • 25 % af patienterne skades (18-33 %) • 96 % af skaderne er mindre alvorlige og forbigående (E-F) • Højst skaderate og størst andel mindre alvorlige skader følges ad Hillerød-studiet • Sammenligning af den fundne skaderate i to uafhængige reviews af de to samme perioder: – 1. januar – 30. juni 2010 – 1. oktober 2011 – 31. marts 2012 – Spørgsmål: Kan et erfarent team reproducere en tidligere fundet skaderate ved måling på en ny stikprøve fra samme periode? Hillerød: udvikling i skaderaten Skader per 1000 liggedage 200 180 160 140 120 100 80 60 40 20 0 Median Konklusion • Hvis reviewprocessen er stabil – Tror vi på at et fald er reelt – Kan vi ikke udelukke, at en stigning skyldes – – Bedre dokumentation Grundigere team • GTT er stadig det bedste overordnede mål • Betydeligt udviklingspotentiale Tak for opmærksomheden! • • • • • Adverse events in hospitals: Methods for identifying events. Washington, DC: U.S. Department of Health and Human Services, Office of Inspector General; 2010 OEI-06-08-00221. Classen DC, Resar R, Griffin F, Federico F, Frankel T, Kimmel N, Whittington JC, Frankel A, Seger A, James BC. “Global trigger tool” shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff (Millwood). 2011;30(4):581-9. Sharek PJ, Parry G, Goldmann D, Bones K, Hackbarth A, Resar R, et al. Performance characteristics of a methodology to quantify adverse events over time in hospitalized patients. Health Serv Res. 2011;46(2):654-78. Naessens JM, O’Byrne TJ, Johnson MG, Vansuch MB, McGlone CM, Huddleston JM. Measuring hospital adverse events: assessing inter-rater reliability and trigger performance of the Global Trigger Tool. Int J Qual Health Care. 2010;22(4):266-74. Solberg LI, Mosser G, McDonald S. The three faces of performance measurement: Improvement, accountability, and research. Joint Commission Journal on Quality Improvement. 1997; 23(3):135-47.
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