Using the electronic health record to build a culture of practice safety: evaluating the implementation of trigger tools in one general practice

作者：Margham Tom; Symes Natalie; Hull Sally A

来源：British Journal of General Practice, 2018, 68(669): E279-E285.

DOI：10.3399/bjgp18X695489

• case notes
• medical errors
• medical records
• organisation and administration
• patient safety
• prevention and control
• primary care
• trigger tools

Background
Identifying patients at risk of harm in general practice is challenging for busy clinicians. In UK primary care, trigger tools and case note reviews are mainly used to identify rates of harm in sample populations.
Aim
This study explores how adaptions to existing trigger tool methodology can identify patient safety events and engage clinicians in ongoing reflective work around safety.
Design and setting
Mixed-method quantitative and narrative evaluation using thematic analysis in a single East London training practice.
Method
The project team developed and tested five trigger searches, supported by Excel worksheets to guide the case review process. Project evaluation included summary statistics of completed worksheets and a qualitative review focused on ease of use, barriers to implementation, and perception of value to clinicians.
Results
Trigger searches identified 204 patients for GP review. Overall, 117 (57%) of cases were reviewed and 62 (53%) of these cases had patient safety events identified. These were usually incidents of omission, including failure to monitor or review. Key themes from interviews with practice members included the fact that GPs' work is generally reactive and GPs welcomed an approach that identified patients who were 'under the radar' of safety. All GPs expressed concern that the tool might identify too many patients at risk of harm, placing further demands on their time.
Conclusion
Electronic trigger tools can identify patients for review in domains of clinical risk for primary care. The high yield of safety events engaged clinicians and provided validation of the need for routine safety checks.

• 出版日期2018-4