Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2018; 7(1): 9-15
Published online Feb 4, 2018. doi: 10.5492/wjccm.v7.i1.9
Adverse events in critical care: Search and active detection through the Trigger Tool
Francisco J Molina, Paula T Rivera, Alejandro Cardona, Diana C Restrepo, Oralia Monroy, Daniel Rodas, Juan G Barrientos
Francisco J Molina, Daniel Rodas, Juan G Barrientos, Clínica Universitaria Bolivariana, School of Medicine, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
Paula T Rivera, Faculty of Nursing, Universidad de Caldas, Manizales 170004, Colombia
Alejandro Cardona, Diana C Restrepo, School of Medicine, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
Oralia Monroy, Clínica Universitaria Bolivariana, Medellín 050034, Colombia
Author contributions: Molina FJ, Restrepo DC and Barrientos JG designed the research; all authors performed the study; Molina FJ, Cardona A, Restrepo DC and Barrientos JG directed use of the analytical tools; all authors analyzed the data; Molina FJ, Cardona A and Barrientos JG wrote the paper.
Institutional review board statement: The study was reviewed and approved for publication by the research directorate of Universidad Pontificia Bolivariana.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors declare no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Francisco J Molina, MSc, Intensivist, Clínica Universitaria Bolivariana, School of Medicine, Universidad Pontificia Bolivariana, Carrera 72a No. 78b-50, Medellín 050034, Colombia. francisco.molina@upb.edu.co
Telephone: +57-313-7452815
Received: August 11, 2017
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
Processing time: 139 Days and 13.5 Hours
Abstract
AIM

To investigate the incidence of disadvantageous events by using the Global Trigger Tool in an intensive care unit (ICU).

METHODS

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.

RESULTS

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).

CONCLUSION

Almost half of the unfavorable issues were classified as avoidable, which leaves a very wide field of work in terms of preventative activities.

Keywords: Adverse events; Critical care; Trigger Tool; Complications; Security

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.