title: A trigger tool fails to identify serious errors and adverse events in pediatric otolaryngology.
abstract: OBJECTIVE
  To identify and quantify errors and adverse events on an inpatient academic tertiary-care pediatric otolaryngology service, a trigger tool was developed and validated as part of a quality improvement initiative.
  
  
  METHODS
  Retrospective record review.
  
  
  METHODS
  Children's Hospital Boston quality improvement initiative.
  
  
  METHODS
  Fifty inpatient admissions were reviewed. The gold standard for errors and adverse events identification was a detailed chart review by two board-certified otolaryngologists blinded to trigger tool findings.
  
  
  RESULTS
  Trigger tool interrater reliability ranged from poor to high for admission triggers (kappa = 0.35, 95% confidence interval [95% CI] -0.07 to 0.76), discharge triggers (kappa = 0.63, 95% CI 0.27-0.99), medical records triggers (kappa = 0.61, 95% CI 0.11-1.00), and medication triggers (kappa = 0.90, 95% CI 0.71-1.00). Errors and adverse events were found in all admissions: three percent were potentially harmful, and 93 percent were documentation-related.
  
  
  CONCLUSIONS
  The trigger tool was successful in identifying clerical and administrative errors and adverse events but failed to identify complex errors and adverse events. A hybrid approach for chart review may be cost-effective in pediatric otolaryngology.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. llander@unmc.edu
authors.forename: Lina
authors.initials: L
authors.lastname: Lander
authors.forename: David W
authors.initials: DW
authors.lastname: Roberson
authors.forename: Katrina M
authors.initials: KM
authors.lastname: Plummer
authors.forename: Peter W
authors.initials: PW
authors.lastname: Forbes
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Healy
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Shah
mesh_terms: D002648:Child; D006801:Humans; D019300:Medical Errors; D008499:Medical Records; D008508:Medication Errors; D015588:Observer Variation; D010036:Otolaryngology; D013517:Otorhinolaryngologic Surgical Procedures; D010343:Patient Admission; D010351:Patient Discharge; D012307:Risk Factors