My regular readers know that, at BIDMC, we keep track of lots of clinical outcomes and post our progress towards our goal of eliminating preventable harm for all to see. But there is a problem. Even with the best of reporting systems and even with a strong no-blame environment that encourages people to report errors and bad outcomes, things go on every day that are undetected or unreported.
So, even though we think we are doing a pretty good job in monitoring our progress, it would be great to triangulate our current methods of reporting and collecting adverse events (aka "harm") with other analytically rigorous approaches. One that we have started to use was developed by the Institute for Healthcare Improvement and is called Global Triggers.
This is a thoughtful and interesting method that is based on reviewing a sample of clinical records each other week to look for "triggers", which are basically clues that a patient may have experienced an adverse impact during his or her treatment. The harm that has occurred to the patient is not necessarily in the category of preventable harm. Rather, it is simply an indication of something going wrong from the patient's point of view.
In a way, the method is similar to the kind of sampling that a manufacturing company uses by taking a small number of widgets out of its assembly line and measuring how many are defective. It turns out that you don't have to take very many to get a statistically valid result. And, if you do it every week in a consistent way, you can see through the week-to-week variation and watch trends over time.
We've just been doing this for a few months now, and IHI says you need at least a year's worth of data to have sufficient observations to have a useful tool. Even though the Global Triggers approach captures all kinds of harm and not just preventable harm, there should be some correlation between the direction of the two categories. We are looking forward to getting those results and monitoring them over time as a way of validating our other reporting tools and feeling more confident about measuring our progress.
Are there others of you out there who have used this IHI methodology and would like to share what you have learned or how it has helped you in your quality improvement programs? If so, please comment.