New ‘trigger tool’ scans EMRs for harms in pediatric hospitals

Patients are harmed at troublingly high rates in hospitals, as evidenced by Medicare’s penalizing of one out of every seven in the current fiscal year. Adding to the worry, hospitals caring for children fare no better on this score than their adult counterparts. So six pediatric hospitals have combined forces to develop and test a new “trigger tool” that retrospectively scans pediatric patients’ EMRs for signs of medical errors.

The good news is that the tool has worked to help identify the most common causes of harm, according to a study on the pilot project in the June issue of Pediatrics. The study was led by David Stockwell, MD, of Children’s National Health System in Washington, D.C.

The study showed the trigger tool detected a total of 240 harms in 600 scans of patient charts, a rate of 40 harms per 100 patients admitted. None of the harms were associated with patient deaths, and almost 70 percent were rated as level E. That’s the lowest severity on the harm scale developed by the National Coordination Council for Medication Error Reporting and Prevention, reflecting problems like rashes and minor bruises.

Still, of the total harms documented, 45 percent were classified as probably or definitely preventable.

In light of that sobering finding, the project represents a promise of progress in the form of “a new tool to survey the electronic medical record,” said David Wessel, MD, chief medical officer of Children’s National. “It is one of many initiatives that are showing us where the opportunities reside to improve care.”

The new Pediatric All-Cause Harm Measurement Tool (PACHMT) is modeled on the adult-focused Global Trigger Tool developed by the Institute for Healthcare Improvement, according to a Children’s National news release. It was tested using a random sample of 100 patients each at Children’s National, Boston Children’s Hospital, Children’s Hospital Central California, Children’s Hospital Colorado, Cincinnati Children’s Hospital Medical Center and Lucile Packard Children’s Hospital Stanford.