A trigger tool fails to identify serious errors and adverse events in pediatric otolaryngology.
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.
Lander
Lina
L
Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. llander@unmc.edu
Roberson
David W
DW
Plummer
Katrina M
KM
Forbes
Peter W
PW
Healy
Gerald B
GB
Shah
Rahul K
RK
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