Identifying adverse events in hospitalized patients using global trigger tool in Thailand

Background: Hospital incidence reporting system has limitation on sensitivity and underreport in detecting the adverse events thus under report them. Trigger tool may provide a more simplified review process for detecting adverse events in a developing country setting. Objectives: To evaluate the effectiveness of the trigger tool on identifying adverse events in Thai hospitalized patients, and to classify the events by the patient safety goals. Materials and methods: A cross-sectional medical record review was conducted to identify adverse events in hospitalized patients at King Chulalongkorn Memorial Hospital during January 2 2008, using the Global Trigger Tool (GTT) by Institute for Healthcare Improvement. Adverse events, severity rating, and preventability were determined by reviewer teams. Types of adverse events were described according to the Patient Safety Goals of Thailand. Results: Five hundred seventy six medical records were reviewed. The total patient-days were 4,460 days. Two hundred thirty six adverse events were detected with a mean rate of 41.0 events per 100 patients or 50.4 events per 1,000 patient-days. One hundred twenty five events (53%) were temporary harm, while 122 (51.7%) were preventable. Regarding the category of adverse event, 75 (31.8%) were related to patient care process, 48 (20.3%) were in safe surgery and 42 (17.8%) were in medication and blood safety. Conclusion: Adverse events using the GTT detected more events than previous reports. Most events had low severity and were preventable. Most events were related to prevention of complications, safe surgery, and medication safety. Assessment of validity is needed before using GTT in medical service.