Adverse events identified by Global Trigger Tool in 245 patients with colon cancer in a well-defined population

Figures & data

Table 1. Triggers (n = 46) used at the reviews

Cares module triggers
1	Transfusion of blood
2	Hemoglobin fall
3	In-hospital stroke
4	Cardiac arrest
5	Dialysis
6	Positive blood culture
7	Deep vein thrombosis or emboli
8	Falls
9	Pressure ulcers
10	Readmission within 30 days
11	Healthcare-associated infections
12	Transfer to higher level of care
13	Documentation of mistakes
14	Other
Medication module triggers
15	Clostridium difficile positive stool
16	APT-time greater than 100 s
17	International normalized ratio (INR) greater than 6
18	Glucose less than 3 mmol/l
19	Serum creatinine two times over baseline
20	Vitamin K/factor concentrate
21	Antihistamine
22	Flumazenil
23	Naloxone
24	Anti-emetics
25	Over sedation/hypotension
26	Abrupt medication stop
Surgical module triggers
27	Reoperation
28	Change in procedure
29	Unplanned postoperative intensive care
30	Intubation/reintubation/CPAP/BiPap
31	X-ray intra-operatively or in postoperative care unit
32	Intra- or postoperative death
33	Mechanical ventilation more than 24 h
34	Intraoperative administration of epinephrine, norepinephrine, naloxone, flumazenil
35	Postoperative increase in troponin levels
36	Change of anesthetic during surgery
37	Consult requested in the postoperative unit
38	Postoperative complication
39	Unsuspected pathology findings
40	Insertion of arterial or central line during surgery
41	Intra-operative time greater than 6 h
42	Removal/injury or repair of organ during surgery
Intensive care module triggers
43	Pneumonia
44	Readmission to ICU
45	Procedures in ICU
46	Intubation/reintubation

Table 2. Tumour stage in 245 patients admitted for colon cancer

Tumor stage	Urgent admittance, n (%)	Elective admittance, n (%)	Total, n (%)
I	1 (1)	17 (10)	18 (7)
II	30 (40)	76 (45)	106 (43)
III	21 (28)	57 (34)	78 (32)
IV	21 (28)	13 (8)	34 (14)
Unknown	2 (3)	7 (4)	9 (4)

Note: The TNM stage was unknown in 9 patients (3.7%) not undergoing bowel resection (biopsy only, radiologic diagnosis.

Table 3. Categories of harm in 88 patients according to NCC MERP

Type	Urgent (n = 34/75)	Elective (n = 54/170)	Total (n = 88/245)
E	10 (13)	17 (10)	27 (11)
F	13 (17)	33 (19)	46 (19)
G	0	0	0
H	0	0	0
I	11 (15)	4 (2)	15 (6)

Notes: Number of patients is shown (percentage within brackets). E reflects an adverse event that required treatment but did not result in prolonged hospital stay, F means a prolonged hospital stay (>7 days after elective surgery and >10 days after urgent admittance) due to the harm, G permanent handicap, H shows that acute life saving measures was demanding in the intensive care unit, I means mortality because of the harm. Adverse events occurred in 44% of patients after urgent admittance and in 32% after elective admittance.

Table 4. Degree of preventability of adverse events related to category of harm, and urgent or elective admittance

Category of harm (NCC MERP)	Degree of preventability (1–4)	Urgent admittance (n = 34)	Elective admittance (n = 54)	Total (n = 88)
E	1	2	1	3
	2	0	0	0
	3	6	13	19
	4	2	3	5
F	1	0	0	0
	2	0	1	1
	3	10	22	32
	4	3	10	13
G		0	0	0
H		0	0	0
I	1	2	1	3
	2	4	0	4
	3	3	3	6
	4	2	0	2

Notes: Not preventable: 1, possibly not preventable: 2, possibly preventable: 3, preventable: 4.

Table 5. Classification of 112 adverse events in 88 out of 245 patients with colon cancer after urgent (n = 75) and elective (n = 170) admittance

Type	Urgent	Elective	Total (n = 245)
Wound infection	6 (8)	16 (9)	22 (9)
Fluid overload (gain in weight >3 kg)	5 (7)	8 (5)	13 (5)
Wound dehiscence	3 (4)	9 (5)	12 (5)
Hospital acquired pneumonia	8 (11)	3 (2)	11 (4)
Gastric retention (requiring gastric tube)	7 (10)	1 (1)	8 (3)
Anastomotic leakage	1 (1)	5 (3)	6 (2)
Postoperative bleeding	1 (1)	5 (3)	6 (2)
Intestinal obstruction	1 (1)	5 (3)	6 (2)
Injury to abdominal organ	2 (3)	3 (2)	5 (2)
Myocardial infarction	4 (5)	0	4 (2)
Stoma complication	3 (4)	1 (1)	4 (2)
Pulmonary embolism	2 (3)	1 (1)	3 (1)
Abdominal abscess	0	3 (2)	3 (1)
Enterocutaneous fistula	0	2 (1)	2 (1)
Miscellaneous	4 (5)	3 (2)	7 (3)

Notes: The table shows the number of patients in each group (percentage within brackets)