title: Characteristics associated with the occurrence of adverse events: a retrospective medical record review using the Global Trigger Tool in a fully digitalized tertiary teaching hospital in Korea.
abstract: OBJECTIVE
  This study aimed to examine the performance of the Global Trigger Tool and to investigate characteristics associated with the occurrence of adverse events (AEs).
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  A tertiary teaching hospital, Korea.
  
  
  METHODS
  We employed two-stage review of a random sample of 630 charts for patients discharged between January and June 2011. Two quality improvement specialists reviewed the presence of AEs using 53 triggers developed by the Institute for Healthcare Improvement. Two physicians reviewed and validated the findings of adverse events. Positive predictive values for individual triggers were calculated. Logistic regression analysis was performed to determine factors associated with AEs.
  
  
  RESULTS
  Of 629 patients, 45 (7%) experienced at least one AE during their hospitalization. Among the observed AEs, 61% were preventable. The frequent types of AEs were 'procedure-related' and 'medication-related'. Six triggers had positive predictive values of greater than 50.0%: 'health care-associated infection', 'any procedure complication', 'medication: other', 'return to surgery', 'occurrence of any operative complication' and 'intubation/reintubation'. Significant factors associated with the occurrence of AEs were length of stay (OR 1.13; 95% CI 1.07 to 1.20) and the number of triggers (OR 1.49; 95% CI 1.11 to 1.98).
  
  
  CONCLUSIONS
  The Global Trigger Tool was useful for the detection of adverse events in a Korean hospital setting. Triggers with high positive predictive values should have priority for incorporation into routine screening systems. Furthermore, patients who stay longer in the hospital need to be closely monitored using triggers to improve patient safety.
authors.affiliation: Department of Nursing, Kyung Hee University, Seoul, South Korea.
authors.forename: Jee-In
authors.initials: JI
authors.lastname: Hwang
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Chin
authors.forename: Yoon-Seok
authors.initials: YS
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration*; D015203:Reproducibility of Results; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: adverse events; global triggers; patient safety; teaching hospital