Development of an Emergency Department Trigger Tool

Document Type : Review Article/ Systematic Review Article/ Meta Analysis

Authors

1 Associate professor of emergency medicine, ,Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Assistant professor of emergency medicine, Clinical Research Development Center, 22 Bahman Hospital, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran

Abstract

Background: Patient safety remains a critical concern for healthcare systems, particularly in developed nations. A substantial proportion of patients experience complications and adverse events attributable to healthcare delivery, exacerbating their initial health issues. Many adverse events are likely to go unnoticed, unreported, and consequently unaddressed. This issue largely stems from inadequate surveillance methods that require significant improvement to achieve excellence in delivering safe, high-quality care for emergency patients.

Objectives: This study aimed to develop an emergency department trigger tool (EDTT) to identify adverse events in the emergency department (ED) to enhance patient safety and quality improvement.

Methods: Conducted under the supervision of Mashhad University of Medical Sciences, this study comprised four stages: (1) a systematic review, (2) refinement and automation of empirical triggers, (3) a modified Delphi process to compile a list of validated triggers from experts, and (4) final environmental data collection to determine the most effective triggers.

Results: The study included a systematic review of electronic resources, revealing no prior Persian equivalent of a trigger tool. A total of 502 articles were identified in PubMed, 100 in Google Scholar, and 410 in Scopus. After removing duplicates and adding four articles based on reference searches, 1,016 article titles were initially reviewed. Two independent researchers evaluated the articles on the same day in two locations. In cases of disagreement, a third researcher's opinion was sought. Ultimately, 295 articles were selected, with high inter-rater reliability (0.82). Forty-two articles were included in the final analysis. The developed tool contained 50 triggers organized into six groups. In a review of 100 ED cases, an average of 1.2 triggers was identified per patient file, with 99 (79.8%) of these triggers attributed to medical errors.

Conclusion: This study successfully designed an emergency department trigger tool (EDTT) utilizing a systematic review and the Delphi method. The resulting trigger tool can be employed to assess high-risk situations and potential emergency medical errors. A significant advantage of this tool over previous versions is its focus on high-risk conditions without relying solely on the absence of appropriate actions as indicators of danger.
 

Keywords

Acknowledgments

The authors would like to thank the administrative staff of emergency department of Imam Reza hospital for their cooperation to access the patients' records.

 

Availability of data and materials

The dataset analyzed during the current study is available upon reasonable request from the corresponding author.

 

Conflicts of interest

The authors have no relevant conflict interests to declare.

 

Consent for publication

 All authors agree to publish the article in the present form.

 

Ethics approval and consent to participate

The study was approved by ethical committee of Mashhad University of medical sciences, Mashhad, Iran. The study was conducted in accordance with the principles of the Helsinki Declaration.

 

Financial disclosure

This study was carried out by the financial support of vice chancellor of research, Mashhad University of medical sciences.

 

Author contributions

The study designed, conceptualized and registered by Pishbin E. Rahmani Sh, Review of records, data collection and interpretation were performed by Pishbin E., Rahmani Sh and Panahi M; Interpretation and data analysis was done by Pishbin E and Rahmani Sh. The manuscript was wrote by Rahmani Sh and all authors reviewed and approved it.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi International Journal of Medicine
Volume 12, Issue 4
November 2024
Pages 1-12

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