May 2012
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Perspectives on Safety
Trigger Tools
INTERVIEW
In Conversation With…David C. Classen, MD, MS
One of the pioneers of the trigger tool methodology for detecting adverse events, Dr. Classen is Chief Medical information Officer at Pascal Metrics and Associate Professor of Medicine at the University of Utah.
Listen to an audio excerpt of the interview
(.MP3 | 14.5 MB)
PERSPECTIVE
The Emergence of the Trigger Tool as the Premier Measurement Strategy for Patient Safety
by Paul J. Sharek, MD, MPH
This piece explains how the trigger tool approach identifies adverse events more efficiently than other detection methods such as voluntary incident reporting and patient safety indicators drawn from administrative data.
Cases & Commentaries
SPOTLIGHT CASE
Inadequate signout to the members of the night float team prevented them from appreciating a patient's mental status changes. Found comatose by the weekend cross-coverage team, the patient had a prolonged ICU stay.
Commentary by
Jeanne M. Farnan, MD, MHPE; and Vineet M. Arora, MD, MAPP
CME/CEU credit available for this case
Diagnosed with cellulitis, an elderly man was admitted to the hospital after receiving the first dose of vancomycin in the ED. Just 3 hours later, a floor nurse noted the admission order for vancomycin every 12 hours and administered another dose.
Commentary by
Jeffrey L. Hackman, MD
After placing a central line in an elderly patient following a heart attack, a community hospital transferred him to a referral hospital for stenting of his coronary arteries. He was discharged to an assisted living facility 2 days later, with the central line still in place.
Commentary by
Marta L. Render, MD
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