The most important contribution of this study is validation of the TT in GSGS and the proposal for the first time of an optimized model. This enables detecting AE more efficiently, which is extremely useful to improve patient safety.
One of the methods used to validate the tool was the opinion of experts with Delphi-like surveys on the triggers included in an initial proposal. For some of them the final model included those with a PPV greater than 5%,19. In others a subsequent study was performed for its validation by means of calculating false negatives in a random sample20.
Some works report the review of trigger histories. This is the case of the Israeli study on TT in AE related to medication. The optimized model proposed was prepared in accordance with PPV over 10% and the opinion of a panel of experts removing four of the 17 initial triggers. This study only reports AE related to medication and the final model is not based on multivariate statistical analysis.
In regard to the predictive capacity of optimized models we found that the study whose results are most similar to this work is the one that uses a similar methodology. In the study by Griffey its model’s area under the curve was 82% with 12 triggers compared to 83.6% in our study.
The PPV of our model (66%) is much higher than that reported in the remaining publications where other methodologies were used with PPV 28.5%19 and 22.1%22 where the selection of triggers is not sufficiently accurate.
The studies detected to date do not report specificity or NPV of the tools used as the histories ruled out that did not contain triggers were not reviewed.
The prevalence of AE detected in our study is greater than that reported in studies on AE17 but similar to that reported in studies where the trigger methodology was used in 7–40% of hospitalized patients20.
In a scope review performed by Schwendimann et al. it was concluded that half the AE were deemed preventable compared to 34% in our study 7. The variability and subjectivity in regard to the preventability of AE was discussed previously. It was recommended not to use this kind of measure.
In regard to the severity of AE, the most common injury category was F with 58%, followed by category E. These outcomes coincide with those reported in the literature24,.
The national study required a large number of reviewers and there may be a certain degree of variability.
The use of HT to identify AE may not capture all AE and information sources may not be reliable. These limitations are part of the IHI’s own methodology.
Validation was performed in a multicenter study including different kinds of hospitals inside the national health system.
However, there was a special focus on training reviewers and homogenization of criteria with close tutoring by the research team.
Antonio Zarco Pleguezuelos1, Manuel Romero Simo1, Albert Caballero Bouza2, David Parés Martinez2, David Paré Martinez2, José María Balibrea Del Castillo3, Xavier Morales Sevillano3, Benjamín Díaz-Zorita Aguilar4, Lorena Martín Román4, Marcos Gomez Ruiz5, Tamara Fernandez Miguel5, Carmen Cagigas Fernandez5, Alejandro Moreno Barsgueiras6, Oscar Cano Valderrama7, Daniel Rivera7, María Gutiérrez Samaniego8, Manuela Elia Guedea9, Elena Cordoba Diaz9, Jose Antonio García Solanas9, Angela Bañuls Matoses10, Ángel Macero10, Jose Daniel Sánchez López11, Mari Antonia Vaquero Pérez11, Jose Alberto Rojo López11, Francisca Lima Pinto11, Eneida Bra Insa12, Ignacio Rodríguez Prieto12,Erlinda Daniela Padilla Zegarra13, Mario Franco Chacon13, Robert Memba Ikuga13, Rosa Joroba Martin13, Fernando Alcaide Matas14, paula Troncoso Pereira14, Víctor Soria Aledo15, Carmen Victoria Pérez Guarinos15, Sixto Genzor Rios16, Miguel Ángel Dobón Rascón16, Sandra Núñez Fernández17, Ernesta Valerias Domínguez17, Manuel García García17, Vanesa Zambrana Campos18, Pere Rebasa Cladera19, Mariano Artés Caselles20, Matías Cea Soriano20, Daniel Gambí Pisonero21, Santos Jiménez de los Galanes22, Maria Dolores Frutos23, Ana Delegido García23, Beatriz Gómez Pérez23, Carlos Montero Zorrilla24, Javier Cortés Climent24, Cristina Vallejo Bernad25, Ruth Bustamante Mosquera25, María Blázquez25, Jesús Muriel López25, Juan Carlos García Pérez26, Juan Ocaña Jiménez26, Gloria Paseiro Crespo27, Cristina Pardo Martínez27, María García Nebreda27, José María Fernández Cebrián28, Virginia Casanova Durán29, Manuel Ferrer Márquez30, Héctor Guadalajara Lavajo31.
General and Digestive Service, General de Alicante Hospital, Alicant.
General and Digestive Service, Germans Trias i Pujol Hospital, Badalona.
General and Digestive Service, Barcelona Clinic Hospital, Barcelona.
General and Digestive Service, Gregorio Marañón University Hospital, Madrid.
General and Digestive Service, Marques de Valdecillla Univesity Hospital, Santander.
General and Digestive Service, 12 de Octubre University Hospital, Madrid.
General and Digestive Service, San Carlos University Hospital, Madrid.
General and Digestive Service, Torrejón de Ardoz University Hospital, Torrejón de Ardoz.
General and Digestive Service, Lozano Blesa University Hospital, Zaragoza.
General and Digestive Service, Francesc de Borja Hospital, Gandía.
General and Digestive Service, Infanta Sofía University Hospital, San Sebastián de los Reyes.
General and Digestive Service, Infanta Cristina University Hospital, Parla.
General and Digestive Service, Joan XXIII University Hospital, Tarragona.
General and Digestive Service, Mateu Ofilia general Hospital, Menorca.
General and Digestive Service, Morales Messeguer University Hospital, Murcia.
General and Digestive Service, Miguel Servet University Hospital, Zaragoza.
General and Digestive Service, Ourense University Hospital, Ourense.
General and Digestive Service, San Jorge University Hospital, Huesca.
General and Digestive Service, Parc Tauli University Hospital, Sabadell.
General and Digestive Service, Puerta de Hierro University Hospital, Madrid.
General and Digestive Service, Santa Bárbara University Hospital, Puerto llano.
General and Digestive Service, Infanta Elena University Hospital, Valdemoro.
General and Digestive Service, Virgen de la Arrixaca University Hospital, Murcia.
General and Digestive Service, Virgen de los Lirios University Hospital, Alcoy.
General and Digestive Service, Álava University Hospital, Victoria.
General and Digestive Service, Ramón y Cajal University Hospital, .
General and Digestive Service, Infanta Leonor University Hospital, Vallecas.
General and Digestive Service, Alcorcón University Hospital, Alcorcón.
General and Digestive Service, Tajo University Hospital, Aranjuez.
General and Digestive Service, Torrecárdenas General Hospital, Almería.
General and Digestive Service, Collado Villalva University Hospital, Villalva.