Development and Implementation of an e-Trigger Tool for Adverse Drug Events in a Swiss University Hospital

Amina El Saghir,1,* Georgios Dimitriou,2,* Miriam Scholer,3 Ioanna Istampoulouoglou,1 Patrick Heinrich,3 Klaus Baumgartl,3 René Schwendimann,4 Stefano Bassetti,2 Anne Leuppi-Taegtmeyer1 1Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Basel, Switzerland; 2Division of Internal Medicine, University Hospital and University of Basel, Basel, Switzerland; 3Department of Information Technology, University Hospital Basel, Basel, Switzerland; 4Patient Safety Office, University Hospital Basel, Basel, Switzerland*These authors contributed equally to this workCorrespondence: Anne Leuppi-TaegtmeyerDepartment of Clinical Pharmacology & Toxicology, University Hospital Basel, Schanzenstrasse 55, Basel, CH4031, SwitzerlandTel +41 61 328 68 48Fax +41 61 265 45 60Email anne.leuppi-taegtmeyer@usb.chPurpose: The purpose of the study was to develop and implement an institution-specific trigger tool based on the Institute for Healthcare Improvement medication module trigger tool (IHI MMTT) in order to detect and monitor ADEs.Methods: We performed an investigator-driven, single-center study using retrospective and prospective patient data to develop (“development phase”) and implement (“implementation phase”) an efficient, institution-specific trigger tool based on the IHI MMTT. Complete medical data from 1008 patients hospitalized in 2018 were used in the development phase. ADEs were identified by chart review. The performance of two versions of the tool was assessed by comparing their sensitivities and specificities. Tool A employed only digitally extracted triggers (“e-trigger-tool”) while Tool B employed an additional manually extracted trigger. The superior tool – taking efficiency into account – was applied prospectively to 19– 22 randomly chosen charts per month for 26 months during the implementation phase.Results: In the development phase, 189 (19%) patients had ≥ 1 ADE (total 277 A