Published online Feb 4, 2018. doi: 10.5492/wjccm.v7.i1.9
Peer-review started: September 16, 2017
First decision: November 7, 2017
Revised: November 20, 2017
Accepted: December 1, 2017
Article in press: December 1, 2017
Published online: February 4, 2018
To investigate the incidence of disadvantageous events by using the Global Trigger Tool in an intensive care unit (ICU).
A retrospective descriptive study was performed in a 12-bed university ICU in the city of Medellin, Colombia. Clinical charts of hospitalized patients were reviewed, between January 1 and December 31, 2016, with the following inclusion criteria: subjects aged over 18 years, with at least 24 h of hospitalization and who had a complete medical history that could be accessed. Interventions: Trained reviewers conducted a retrospective examination of medical charts searching for clue events that elicit investigation, in order to detect an unfavorable event. Measurements: Information was processed through SPSS software version 21; for numerical variables, the mean was reported with standard deviation (SD). Percentages were calculated for qualitative variables.
Two hundred and forty-four triggers occurred, with 82.4% of subjects having presented with at least one and an average of 3.37 (SD 3.47). A total of 178 adverse events (AEs) took place in 48 individuals, with an incidence of 52.1%. On average, four events per patient were recorded, and for each unfortunate event, 1.98 triggers were presented. The most frequent displeasing issues were: pressure ulcers (17.6%), followed by complications or reactions to medical devices (4.3%), and lacerations or skin defects (3.7%); the least frequent was delayed diagnosis or treatment (0.56%). Thirty-eight point four percent of mishap events caused temporary damage that required intervention, and 48.9% of AEs were preventable. Comparison between AEs and admission diagnoses found that hypertension and sepsis were the only diagnoses that had statistical significance (P = 0.042 and 0.022, respectively).
Almost half of the unfavorable issues were classified as avoidable, which leaves a very wide field of work in terms of preventative activities.
Core tip: The Global Trigger Tool is a type of active detection of adverse events (AEs). Three studies carried out in intensive care units (ICUs), which included only patients who died in the following 96 h or 7 d prior to ICU admission. The importance of our study is that it was performed during the entire hospital stay in the ICU. The incidence of AEs was 52.1%, and 48.9% of these were preventable. The most frequent were pressure ulcers (17.6%) and complications related to medical devices (4.3%). The three main triggers were skin defects, excitation or drowsiness, and unscheduled withdrawal of surgical catheter, probes, or drains.