Table 3 Triggers given the first and second time of screening
From: The Harvard medical practice study trigger system performance in deceased patients
Triggers | Description | First time positive (N)1 | Second time positive (N)a | Percentage agreement (%) | Kappa agreement (95%CI) | McNemar’s test (p-value) | PABAKb (95%CI) | Bias index | Prevalence index |
|---|---|---|---|---|---|---|---|---|---|
Trigger 1 | Unplanned readmissionc (within 3 months) after discharge from index admission | 13 | 17 | 88 | 0.53 (0.30–0.76) | 0.39 | 0.76 (0.58–0.88) | − 0.04 | − 0.7 |
Trigger 2 | Hospital-incurred patient injury (temporarily or lasting) | 8 | 4 | 90 | 0.12 (−0.17–0.41) | 0.34 | 0.80 (0.63–0.90) | 0.04 | −0.88 |
Trigger 3 | Adverse drug reaction | 2 | 6 | 92 | −0.03 (− 0.06–0.002) | 0.29 | 0.84 (0.68–0.93) | − 0.04 | − 0.92 |
Trigger 4 | Unplanned transfer to the ICU | 15 | 18 | 93 | 0.75 (0.57–0.92) | 0.45 | 0.86 (0.70–0.94) | −0.03 | − 0.67 |
Trigger 5 | Unplanned return to the operating room | 8 | 12 | 96 | 0.78 (0.59–0.99) | 0.13 | 0.92 (0.78–0.98) | −0.04 | − 0.80 |
Trigger 6 | Unplanned removal, injury or repair of an organ during surgery | 5 | 6 | 95 | 0.52 (0.15–0.89) | 1.00 | 0.90 (0.75–0.97) | −0.01 | −0.89 |
Trigger 7 | Healthcare related infection or sepsis | 20 | 22 | 88 | 0.64 (0.45–0.83) | 0.77 | 0.76 (0.58–0.88) | −0.02 | − 0.58 |
Trigger 8 | Other complications such as CVA/lung embolism/acute myocardial infarction/TIA | 17 | 16 | 89 | 0.60 (0.38–0.81) | 1.00 | 0.78 (0.60–0.89) | 0.01 | −0.67 |
Trigger 9 | Development of neurological deficit which was not present on admission | 5 | 7 | 92 | 0.29 (−0.06–0.65) | 0.73 | 0.84 (0.68–0.93) | −0.02 | − 0.88 |
Trigger 10 | (Initial) unexpected and/or sudden death, (no palliative care) | 12 | 14 | 84 | 0.29 (0.03–0.55) | 0.80 | 0.68 (0.49–0.81) | −0.02 | −0.74 |
Trigger 11 | Cardiac or respiratory arrest | 12 | 11 | 93 | 0.66 (0.42–0.89) | 1.00 | 0.86 (0.70–0.94) | 0.01 | −0.77 |
Trigger 12d | Injury related to abortion or delivery | – | – | – | – | – | – | – | – |
Trigger 13 | Dissatisfaction with care documented in the record | 2 | 5 | 95 | 0.27 (−0.17–0.71) | 0.38 | 0.90 (0.75–0.97) | −0.03 | − 0.93 |
Trigger 14 | Documentation indicating a legal claim or complaint proceduree | 0 | 2 | – | – | – | – | – | – |
Trigger 15 | Other patient complication | 5 | 27 | 72 | 0.04 (−0.10–0.189) | 0.00 | 0.44 (0.23–0.62) | −0.22 | − 0.68 |