1015 / Adaptation of trigger-tool to a surgical service

SPAIN
Classification of the PSP
Type of Patient Safety Practice Potentially Safe
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Identification of risk and harm
There is no specified text here There is no specified text here
Topic of the reported practice
Clinical risk management
Aim and the benefit of the Patient Safety Practice
 
The objective is to obtain a useful tool for a General and Digestive Surgery Department in order to detect adverse events in an efficient way through some situations (“triggers”) closely related to adverse events. It´s important to detect the triggers in a short time. If we find a trigger we proceed to review the clinical record to look for an adverse event. Then, you categorize it regarding severity and preventability and proceed accordingly.
Description of the Patient Safety Practice
 
We´ve chosen a trigger-tool panel, considering some of the IHI (Institute for Healthcare Improvement) triggers and others collected from a bibliographic review and experts' opinion.

After studying sensitivity and specificity for adverse events' detection and having applied logistic regression, we can offer a selection of few triggers that can detect many of adverse events.

•    Methodology: in 2012 we studied a representative sample of 350 patients treated in 3 General and Digestive Surgery departments in Hospital 12 de Octubre (Madrid), using the following triggers:

I. Care Triggers
•    Transfusion or use of blood products*
•    Code/arrest/rapid response team*
•    Positive blood culture*
•    X-ray or Doppler studies for emboli or DVT (Deep Vein Thrombosis)*
•    Readmission within 30 days*
•    Transfer to higher level of care*

II.Surgical Triggers
•    Return to surgery*
•    Change in procedure*
•    Admission to intensive care post-op*
•    Intubation/reintubation/BiPap in Post*
•    Intra-op or post-op death*
•    Mechanical ventilation greater than 24 hours post-op*.
•    Injury, repair, or removal of organ*

*Triggers collected from IHI proposal.

III.Triggers collected from literature and experts´ opinion.
•    Pathology report not related to the original diagnosis.
•    Increased stay in post-op recovery unit.
•    Admissions in Emergency department within 30 days after discharge.
•    Invasive procedures
•    No planned radiology
•    Broad spectrum antibiotherapy
•    Parenteral nutrition.

After reviewing references about the trigger-tool we´ve selected a panel easy to find using only electronic information. We intended to analyze all triggers for every patient in less than 5 minutes and to get a high sensitivity and specificity.

•    Results and Proposal of Trigger Panel:

We found positive triggers in 125 cases (35,71%) and 165 adverse events were detected using the triggers. In summary:

    Sensitivity: 86%
    Specificity: 93,6%
    Predictive positive value: 86%
    Predictive negative value: 93%

Finally, we propose to use a panel of only 8 triggers, that can predict 98% of adverse events:

1.    Intra-op or post-op death.
2.    Readmission within 30 days.
3.    Admission to intensive care post-op.
4.    Increased stay in post-op recovery unit.
5.    Return to surgery.
6.    No planned radiology.
7.    Positive blood culture.
8.    Parenteral nutrition.

Study team:

Ana Isabel Pérez Zapata
María Gutiérrez Samaniego
Elías Rodríguez Cuélla
Agustín Gómez de la Cámara
Pedro Ruiz López
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
There is no specified text here
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, partly
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Not known
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
No
Evaluation of a "positive" effect of the reported practice on Patient Safety
Effect not known or the intervention has not yet been evaluated
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Pharmacists
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
No
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Pedro Ruiz-López
Country: SPAIN
Organisation: Hospital Universitario 12 de Octubre
E-mail: pruizl@salud.madrid.org
Phone: 34913908164
Print
Top