Researchers funded by the Agency for Healthcare Research and Quality (AHRQ) have developed a new tool to make care safer at children’s hospitals. A study published in the journal Pediatrics outlines the development and testing of the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, which can use electronic or written data to retrospectively identify adverse events in pediatric patients.
“This tool will help doctors and other practitioners caring for children to develop safer practices,” said AHRQ Director Andy Bindman, M.D. “A reliable trigger tool will help clinicians recognize potential safety concerns quickly from routine information collected from the medical record. Making providers aware of this information will help them avoid similar mistakes in the future.”
Trigger tools are commonly used to screen for adverse events after they occur. A trigger tool is used to scan an electronic or paper health record system and flag entries that indicate an adverse event may have occurred. For instance, if a health record shows a patient on insulin developed low blood sugar, the tool would prompt a nurse or other safety health care worker to follow up to determine if the hospital failed to give the patient correct insulin dosages. Going forward, hospitals would learn from this assessment how to effectively and appropriately track patients’ insulin dosages and examine trends in how many and what kind of adverse events are occurring.
Trigger tools can improve patient safety by helping quality improvement staff identify and report adverse events, making them easier to identify and track over time—as opposed to passive voluntary reporting systems, which detect only a small percentage of adverse events. Augmenting voluntary reporting with systematic surveillance using trigger tools may improve understanding about safety vulnerabilities, and better understanding and measurement of patient safety will be essential in efforts to address the harm due to medical care.
Adverse events are incidents in which medical care causes harm to patients. A study published in BMJ estimated that more than 250,000 patients die each year in the United States from problems such as surgical or medication errors. Adverse events are the nation’s third leading cause of death after heart disease and cancer.
The GAPPS tool represents the most rigorously developed and widely tested pediatric tool of its kind. To develop it, researchers at the AHRQ-funded Center of Excellence for Pediatric Quality Measurement at Boston Children’s Hospital built on previous efforts that have largely focused on trigger tools for adult patients. They convened an expert panel, conducted a detailed trigger-by-trigger analysis, and field-tested the tool on more than 3,800 medical records from 16 academic and community hospitals across the country. The GAPPS Tool was then refined based on performance of the triggers.
“Reliable measurement of adverse events is critical for providers to determine how effective efforts to improve pediatric patient safety are,” said the study’s lead author, Christopher P. Landrigan, M.D., M.P.H., who is an associate professor of pediatrics and medicine at Harvard Medical School and research director of the inpatient pediatrics service at Boston Children’s Hospital. “The GAPPS tool represents a substantial advance over voluntary reporting systems, because it is far more sensitive and consistent.”