Does Skilled Nursing Facility Trigger Tool used with Global Trigger Tool increase its value for adverse events evaluation?

Abstract

Objective: To assess the additional value in the evaluation of incidents and adverse events by adding the IHI Skilled Nursing Facility Trigger Tool (SNFTT) to the Institute for Healthcare Improvement's Global Trigger Tool (GTT) in an acute geriatric hospital.

Material and methods: A one-year retrospective study reviewing 240 electronic clinical records using the general GTT, either alone or combined with SNFTT.

Main outcome measures: Number of triggers and identified adverse events (AEs), categories of severity and preventability of AEs, GTT incidence rates, and the number needed to alert (NNA).

Results: One hundred and thirty-seven AEs were identified in 107 patients (57.1 AEs per 100 admissions). Of these, 127 (92.7%) occurred 3 or more days after admissions; 49.6% of the harm events were preventable. The NNA for GTT plus SNFTT was 8.6. No significant difference was found using the general GTT alone versus the general GTT plus SNFTT in terms of the main outcome measures. Eleven categories of triggers were better identified when using GTT plus SNFTT because with GTT alone they were allocated to a category of "Other": 9 from the care module (C15) and 2 from the medication module (M13).

Conclusions: The study demonstrates that adding the SNFTT to the GTT did not increase its effectiveness as regards the evaluation of AEs. However, some triggers are better described in SNFTT and now have now been added into the general GTT method in our hospital.

Keywords: Adverse events; Atención sanitaria; Episodios adversos; Geriatrics; Geriatría; Global Trigger Tool; Global trigger tool; Healthcare; Patient safety; Seguridad del paciente; Skilled Nursing Facility Trigger Tool.