Authors (including presenting author) :
Leung SK(1), Kwan GWM(2), Hui WH(1), Tang PF(2), Gill NP (3)
Affiliation :
(1) Department of Surgery, Tuen Mun Hospital,(2) Quality & Safety Division, Tuen Mun Hopsital, (3) Department of Family Medicine & Primary Health Care
Introduction :
IHI GTT is a standardized assessment tool for retrospective patient record review using specific triggers to identify adverse events (AEs) during a specific admission and analyze the harm caused according to National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP).
Objectives :
Proactive review of AEs in TMH surgical department from FEB 2015 to JAN 2020
Methodology :
10 random surgical cases with age >=18years old and admission of >=5 days in every 2 weeks and those were discharged more than 90 days with the completeness of discharge summary are reviewed by using GTT during the period 2015 to 2020. The modules applicable to our review included: the first three (care / medication / surgical), with a comprehensive list of trigger used in our center.
Result & Outcome :
1200 surgical cases were reviewed. We had a total of 534 patients (44.5%) that were aged < 65 years old and 666 patients (55.5%) aged >=65 years old. The mean age of our patients were 65.7 years old. We had 697 patients that were male (58.1%) and 503 patients that were female (41.9%). We found that gender and age were not significantly associated with harm. The mean Number of Adverse Events per 1,000 Patient Days for Surgery Patients = 37.4. The mean Number of Adverse Events per 100 Admissions for Surgery Patients = 44.2, Percentage of Admissions with Adverse Events for Surgery Patients = 33.1. We analyzed the length of stay (LOS) of our patients and the average was 11.8 days. Those without any harm inflicted had an average LOS of 9.3 days. We found that age was not significantly correlated to the LOS (p=0.344), the male and gender was also not significantly associated with the hospital LOS (p=0.332). We compared the relationship between harm and the LOS which was shown to be significant (p< 0.001), but the level of harm did not show to affect LOS in a significant way (p=0.079). Top 10 triggers: Care module (others) = 850; Care module (readmission within 30days) = 408; Medication module (anti-emetic use) = 283; Care module (hemoglobin drop >25%) = 239; Care module (blood product transfusion) = 222; Surgical module (post-op complications) = 241; Surgical module (others) = 186; Care module (restraint use) = 173; Care module (hospital acquired infection) = 117; No triggers = 143. The more the number of triggers per case, the more likely of harm and more severe the harm. Most common AEs: Catheter associated UTI, Surgical site infection, Non-ventilator associated respiratory infection, Post-operation prolonged ileus, Medication related bleeding, Abnormal bleeding following surgery, Medication related hypoglycemia, Hypotension. Total of 535 cases of harm identified: 510 cases (95.3%) category E,F harm 25 cases (< 5%) category G,H,I harm Of the 13 cases of category G harm (permanent harm), 8 were under “removal/injury/repair of visceral organ” AE. The 10 cases of category H harm (intervention required to sustain life), respiratory and cardiac causes were most common. The 2 cases of category I harm (patient death) were due to post-operation infection and medication related complication. There was significant relationship between harm and LOS but no significant relation between level of harm and LOS. DISCUSSION Our results were compared with 2 other trials using IHI GTT from Sweden and China and were largely comparable. Using this data and identifying the AEs, we could improve our care such as addressing issues of hospital acquired infections by advising clinical practice changes.
