Development of a trigger tool to identify adverse events and harm in Emergency Medical Services.
BACKGROUND
Adverse event(AE)detection in healthcare has traditionally relied upon several methods including: patient care documentation review, mortality and morbidity review, voluntary reporting, direct observation and complaint systems. A novel sampling strategy, known as the trigger tool (TT) methodology, has been shown to provide a more robust and valid method of detection. The aim of this research was to develop and assess a TT specific to ground-based Emergency Medical Services, to identify cases with the potential risk for adverse events and harm.


METHODS
The study was conducted between March and December 2015. A literature review identified 57 potential triggers, which were grouped together by experts using an affinity process. Triggers for other areas of potential AE/harm were additionally considered for inclusion. An interim TT consisting of nine triggers underwent five iterative rounds of derivation tests of 20 random patient care records (n=100) in two emergency medical services. A final eight-item trigger list underwent a large sample (n=9836) assessment of test characteristics.


RESULTS
The final eight-item TT consisted of triggers divided amongst four categories:Clinical,Medication,ProceduralandReturn-Call. The TT demonstrated an AE identification rate of 41.5% (sensitivity 79.8% (95% CI, 69.9% to 87.6%); specificity 58.5% (95% CI, 52% to 64.8%)). When identifying potential risk for harm, the TT demonstrated a harm identification rate of 19.3% (sensitivity 97.1% (95% CI, 84.7% to 99.9%); specificity 53.5% (95% CI, 47.7% to 59.3%)).


CONCLUSIONS
The Emergency Medical Services Trigger Tool (EMSTT) may be used as a sampling strategy similar to the Global Trigger Tool, to identify and measure AE and harm over time, and monitor the success of improvement initiatives within the Emergency Medical Services setting.
Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar.
Ian Lucas
IL
Howard
Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar.
James Marcus
JM
Bowen
Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar.
Loua Asad Hanna
LAH
Al Shaikh
Research and Development, Institute for Healthcare Improvement, Cambridge, USA.
Kedar Shrikrishna
KS
Mate
Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar.
Robert Campbell
RC
Owen
Improvement Capability, Institute for Healthcare Improvement, Cambridge, USA.
David Michael
DM
Williams
D004632:Emergency Medical Services / Q000379:methods / Q000639:trends*; D005544:Forecasting / Q000379:methods*; D006801:Humans; D019300:Medical Errors; D061214:Patient Safety / Q000592:standards*; D015985:Precipitating Factors; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D017751:Safety Management / Q000379:methods; D012680:Sensitivity and Specificity
Adverse Event; Ambulance; Emergency Medical Service; Harm; Paramedic; Patient Safety; Quality