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Development of an Emergency Department Trigger Tool Using a Systematic Search and Modified Delphi Process.

Publication ,  Journal Article
Griffey, RT; Schneider, RM; Adler, LM; Capp, R; Carpenter, CR; Farmer, BM; Groner, KY; Hodkins, S; McCammon, CA; Powell, JT; Sather, JE ...
Published in: J Patient Saf
March 2020

OBJECTIVE: This study aimed to develop an emergency department (ED) trigger tool to improve the identification of adverse events in the ED and that can be used to direct patient safety and quality improvement. This work describes the first step toward the development of an ED all-cause harm measurement tool by experts in the field. METHODS: We identified a multidisciplinary group of emergency medicine safety experts from whom we solicited candidate triggers. We then conducted a modified Delphi process consisting of 4 stages as follows: (1) a systematic literature search and review, including an independent oversampling of review for inclusion, (2) solicitation of empiric triggers from participants, (3) a Web-based survey ranking triggers on specific performance constructs, and (4) a final in-person meeting to arrive at consensus triggers for testing. Results of each step were shared with participants between each stage. RESULTS: Among an initial 804 unique articles found using our search criteria, we identified 94 that were suitable for further review. Interrater reliability was high (κ = 0.80). Review of these articles yielded 56 candidate triggers. These were supplemented by 58 participant-submitted triggers yielding a total of 114 candidate triggers that were shared with team members electronically along with their definitions. Team members then voted on each measure via a Web-based survey, ranking triggers on their face validity, utility for quality improvement, and fidelity (sensitivity/specificity). Participants were also provided the ability to flag any trigger about which they had questions or they felt merited further discussion at the in-person meeting. Triggers were ranked by combining the first 2 categories (face validity and utility), and information on fidelity was reviewed for decision making at the in-person meeting. Seven redundant triggers were eliminated. At an in-person meeting including representatives from all facilities, we presented the 50 top-ranked triggers as well as those that were flagged on the survey by 2 or more participants. We reviewed each trigger individually, identifying 41 triggers about which there was a clear agreement for inclusion. Of the seven additional triggers that required subsequent voting via e-mail, 5 were adopted, arriving at a total of 46 consensus-derived triggers. CONCLUSIONS: Our modified Delphi process resulted in the identification of 46 final triggers for the detection of adverse events among ED patients. These triggers should be pilot field tested to quantify their individual and collective performance in detecting all-cause harm to ED patients.

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Published In

J Patient Saf

DOI

EISSN

1549-8425

Publication Date

March 2020

Volume

16

Issue

1

Start / End Page

e11 / e17

Location

United States

Related Subject Headings

  • Reproducibility of Results
  • Quality Improvement
  • Humans
  • Health Policy & Services
  • Emergency Service, Hospital
  • Delphi Technique
  • 4203 Health services and systems
  • 1117 Public Health and Health Services
 

Citation

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Griffey, R. T., Schneider, R. M., Adler, L. M., Capp, R., Carpenter, C. R., Farmer, B. M., … Wiler, J. L. (2020). Development of an Emergency Department Trigger Tool Using a Systematic Search and Modified Delphi Process. J Patient Saf, 16(1), e11–e17. https://doi.org/10.1097/PTS.0000000000000243
Griffey, Richard Thomas, Ryan M. Schneider, Lee M. Adler, Roberta Capp, Christopher R. Carpenter, Brenna M. Farmer, Kathyrn Y. Groner, et al. “Development of an Emergency Department Trigger Tool Using a Systematic Search and Modified Delphi Process.J Patient Saf 16, no. 1 (March 2020): e11–17. https://doi.org/10.1097/PTS.0000000000000243.
Griffey RT, Schneider RM, Adler LM, Capp R, Carpenter CR, Farmer BM, et al. Development of an Emergency Department Trigger Tool Using a Systematic Search and Modified Delphi Process. J Patient Saf. 2020 Mar;16(1):e11–7.
Griffey, Richard Thomas, et al. “Development of an Emergency Department Trigger Tool Using a Systematic Search and Modified Delphi Process.J Patient Saf, vol. 16, no. 1, Mar. 2020, pp. e11–17. Pubmed, doi:10.1097/PTS.0000000000000243.
Griffey RT, Schneider RM, Adler LM, Capp R, Carpenter CR, Farmer BM, Groner KY, Hodkins S, McCammon CA, Powell JT, Sather JE, Schuur JD, Shapiro MJ, Sharp BR, Venkatesh AK, Vrablik MC, Wiler JL. Development of an Emergency Department Trigger Tool Using a Systematic Search and Modified Delphi Process. J Patient Saf. 2020 Mar;16(1):e11–e17.

Published In

J Patient Saf

DOI

EISSN

1549-8425

Publication Date

March 2020

Volume

16

Issue

1

Start / End Page

e11 / e17

Location

United States

Related Subject Headings

  • Reproducibility of Results
  • Quality Improvement
  • Humans
  • Health Policy & Services
  • Emergency Service, Hospital
  • Delphi Technique
  • 4203 Health services and systems
  • 1117 Public Health and Health Services