Performance characteristics of a methodology to quantify adverse events over time in hospitalized patients.
OBJECTIVE
To assess the performance characteristics of the Institute for Healthcare Improvement Global Trigger Tool (GTT) to determine its reliability for tracking local and national adverse event rates.


METHODS
Primary data from 2008 chart reviews.


METHODS
A retrospective study in a stratified random sample of 10 North Carolina hospitals. Hospital-based (internal) and contract research organization-hired (external) reviewers used the GTT to identify adverse events in the same 10 randomly selected medical records per hospital in each quarter from January 2002 through December 2007.


METHODS
Interrater and intrarater reliability was assessed using κ statistics on 10 percent and 5 percent, respectively, of selected medical records. Additionally, experienced GTT users reviewed 10 percent of records to calculate internal and external teams' sensitivity and specificity.


RESULTS
Eighty-eight to 98 percent of the targeted 2,400 medical records were reviewed. The reliability of the GTT to detect the presence, number, and severity of adverse events varied from κ=0.40 to 0.60. When compared with a team of experienced reviewers, the internal teams' sensitivity (49 percent) and specificity (94 percent) exceeded the external teams' (34 and 93 percent), as did their performance on all other metrics.


CONCLUSIONS
The high specificity, moderate sensitivity, and favorable interrater and intrarater reliability of the GTT make it appropriate for tracking local and national adverse event rates. The strong performance of hospital-based reviewers supports their use in future studies.
Sharek
Paul J
PJ
Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital and Stanford University School of Medicine, Palo Alto, CA 94304, USA. psharek@lpch.org
Parry
Gareth
G
Goldmann
Donald
D
Bones
Kate
K
Hackbarth
Andrew
A
Resar
Roger
R
Griffin
Frances A
FA
Rhoda
Dale
D
Murphy
Cathy
C
Landrigan
Christopher P
CP
D000368:Aged; D005260:Female; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D019300:Medical Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina; D015588:Observer Variation; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards; D012189:Retrospective Studies; D012449:Safety / Q000706:statistics & numerical data; D017751:Safety Management