Development and Implementation of an e-Trigger Tool for Adverse Drug Events in a Swiss University Hospital

Abstract

Purpose

The purpose of the study was to develop and implement an institution-specific trigger tool based on the Institute for Healthcare Improvement medication module trigger tool (IHI MMTT) in order to detect and monitor ADEs.

Methods

We performed an investigator-driven, single-center study using retrospective and prospective patient data to develop (“development phase”) and implement (“implementation phase”) an efficient, institution-specific trigger tool based on the IHI MMTT. Complete medical data from 1008 patients hospitalized in 2018 were used in the development phase. ADEs were identified by chart review. The performance of two versions of the tool was assessed by comparing their sensitivities and specificities. Tool A employed only digitally extracted triggers (“e-trigger-tool”) while Tool B employed an additional manually extracted trigger. The superior tool – taking efficiency into account – was applied prospectively to 19–22 randomly chosen charts per month for 26 months during the implementation phase.

Results

In the development phase, 189 (19%) patients had ≥1 ADE (total 277 ADEs). The time needed to identify these ADEs was 15 minutes/chart. A total of 203 patients had ≥1 trigger (total 273 triggers – Tool B). The sensitivities and specificities of Tools A and B were 0.41 and 0.86, and 0.43 and 0.86, respectively. Tool A was more time-efficient than Tool B (4 vs 9 minutes/chart) and was therefore used in the implementation phase. During the 26-month implementation phase, 22 patients experienced trigger-identified ADEs and 529 did not. The median number of ADEs per 1000 patient days was 6 (range 0–13). Patients with at least one ADE had a mean hospital stay of 22.3 ± 19.7 days, compared to 8.0 ± 7.6 days for those without an ADE (p = 2.7×10⁻¹⁴).

Conclusion

We developed and implemented an e-trigger tool that was specific and moderately sensitive, gave consistent results and required minimal resources.

Keywords:

• electronic health record
• medication module
• drug safety
• patient safety
• digital health

Author Contributions

Study idea (ALT), data acquisition and analysis (AES, MS, GD, II, PH, KB, ALT), data interpretation (AES, GD, ALT, RS, SB) and writing (AES, GD, II, RS, ALT). All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Amina El Saghir and Georgios Dimitriou are co-first authors for this study. The authors have no competing interests to declare.

Additional information

Funding

There was no specific funding for the study.