Haytham Kaafarani, MD, MPH, Amy K.Rosen, PhD, Jonathan Nebeker, MD, MS, Stephanie Shimada, PhD, Peter Rivard, PhD, MHSA, Hillary Mull, MPP, Brenna Long, MS, Marlena H. Shin, JD, MPH, Lucy Savitz , PhD, Kamal M.F. Itani, MD
VA Boston Healthcare System- Department of Surgery, Center for Health, Quality, Outcomes and Economic Research; Boston, MA
PURPOSE OF STUDY
Background The trigger tool methodology uses clinical algorithms applied electronically to “flag” patient medical records where adverse events (AEs) have most likely occurred. The ultimate goal is to improve quality of care by focusing efforts at AE surveillance. We sought to create surgical triggers applicable to ambulatory care.
Methods Three consecutive steps were used to develop ambulatory surgery triggers. First, we conducted a comprehensive literature review for surgical triggers. Second, a series of multidisciplinary focus groups (physicians, nurses, pharmacists and information technology specialists) provided user input on trigger selection. Third, a rigorous three-phase Delphi process (surgical and trigger tool experts) evaluated and refined a set of ten triggers.
SUMMARY OF RESULTS:
Results We designed an initial set of ten triggers including five global triggers (flagging the chart for the suspicion of any AE), and five AE-specific triggers (flagging the chart for the suspicion of a specific AE). In Table 1, we report our final set of five surgical triggers based on the Delphi members ranking of the triggers’ utilities for system intervention.
Conclusion Trigger tools promise an innovative, efficient and focused methodology for surveillance of adverse events in ambulatory surgery. The next step is to measure the test characteristics of the designed triggers.
TABLES AND CHARTS:
Table 1: Ambulatory Surgery Trigger Tools
|Trigger Rules||Trigger Type|
|Same-day Surgery AND Subsequent ED visit < 21 days||Global|
|Same-day Surgery AND Unscheduled re-admission to hospital < 30 days||Global|
|Same-day surgery AND Unscheduled procedure (interventional radiological OR urological OR dental OR cardiac OR gastroenterological) OR re-operation < 30 days||Global|
|Scheduled same-day surgery AND Observation stay > 24 hours||Global|
|Same-Day surgery AND Postoperative lower extremity Doppler U/S order entry AND (ICD code for DVT OR ICD code for PE < 30 days)||AE-specific|