title: Measuring adverse events and levels of harm in pediatric inpatients with the Global Trigger Tool.
abstract: OBJECTIVE
  To evaluate and characterize the Global Trigger Tool's (GTT's) utility in a pediatric population; to measure the rate of harm at our institution and compare it with previously established trigger tools and benchmark rates; and to describe the distribution of harm of the detected events.
  
  
  METHODS
  Per the GTT methodology, 240 random inpatient charts were retrospectively reviewed over a 12-month pilot period for the presence of 53 predefined safety triggers. When triggers were detected, the reviewers investigated the chart more thoroughly to decide whether an adverse event occurred. Agreement with a physician reviewer was then reached, and a level of harm was assigned.
  
  
  RESULTS
  A total of 404 triggers were detected (1.7 triggers per patient), and 88 adverse events were identified. Rates of 36.7 adverse events per 100 admissions and 76.3 adverse events per 1000 patient-days were calculated. Sixty-two patients (25.8%) had at least 1 adverse event during their hospitalization, and 18 (7.5%) had >1 event identified. Three-quarters of the events were category E (temporary harm). Two events required intervention to sustain life (category H). Two of the 6 trigger modules identified 95% of the adverse events.
  
  
  CONCLUSIONS
  The GTT demonstrated utility in the pediatric inpatient setting. With the use of the trigger tool, we identified a rate of harm 2 to 3 times higher than previously published pediatric rates. Modifications to the trigger tool to address pediatric-specific issues could increase the test characteristics of the tool.
authors.affiliation: Division of Hospital Medicine, Medical Director of Clinical Decision Support, Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. eric.kirkendall@cchmc.org
authors.forename: Eric S
authors.initials: ES
authors.lastname: Kirkendall
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kloppenborg
authors.forename: James
authors.initials: J
authors.lastname: Papp
authors.forename: Denise
authors.initials: D
authors.lastname: White
authors.forename: Carol
authors.initials: C
authors.lastname: Frese
authors.forename: Deborah
authors.initials: D
authors.lastname: Hacker
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schoettker
authors.forename: Stephen
authors.initials: S
authors.lastname: Muething
authors.forename: Uma
authors.initials: U
authors.lastname: Kotagal
mesh_terms: D002648:Child; D003663:Decision Trees; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000592:standards*; D012189:Retrospective Studies