Applying the trigger review method after a brief educational intervention: potential for teaching and improving safety in GP specialty training?

BMC Medical Education

Paul Bowie¹  Moya Kelly¹  Carl de Wet²  John McKay¹ 

[1] Postgraduate GP Education, NHS Education for Scotland, Glasgow, UK;General Practice & Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Science, University of Glasgow, Glasgow, UK

关键词: Clinical audit;    GP training;    Clinical record review;    Trigger tool;    Primary care;    General practice;    Patient safety;   

Others  :  1138763
DOI  :  10.1186/1472-6920-13-117

 received in 2013-01-09, accepted in 2013-08-26,  发布年份 2013

【 摘 要 】

Background

The Trigger Review Method (TRM) is a structured approach to screening clinical records for undetected patient safety incidents (PSIs) and identifying learning and improvement opportunities. In Scotland, TRM participation can inform GP appraisal and has been included as a core component of the national primary care patient safety programme that was launched in March 2013. However, the clinical workforce needs up-skilled and the potential of TRM in GP training has yet to be tested. Current TRM training utilizes a workplace face-to-face session by a GP expert, which is not feasible. A less costly, more sustainable educational intervention is necessary to build capability at scale. We aimed to determine the feasibility and impact of TRM and a related training intervention in GP training.

Methods

We recruited 25 west of Scotland GP trainees to attend a 2-hour TRM workshop. Trainees then applied TRM to 25 clinical records and returned findings within 4-weeks. A follow-up feedback workshop was held.

Results

21/25 trainees (84%) completed the task. 520 records yielded 80 undetected PSIs (15.4%). 36/80 were judged potentially preventable (45%) with 35/80 classified as causing moderate to severe harm (44%). Trainees described a range of potential learning and improvement plans. Training was positively received and appeared to be successful given these findings. TRM was valued as a safety improvement tool by most participants.

Conclusion

This small study provides further evidence of TRM utility and how to teach it pragmatically. TRM is of potential value in GP patient safety curriculum delivery and preparing trainees for future safety improvement expectations.

【 授权许可】

   
2013 McKay et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]de Wet C, Bowie P: Screening electronic patient records to detect preventable harm: a trigger tool for primary care. Qual Prim Care 2011, 19(2):115-125.
• [2]Griffin FA, Resar RK: IHI Global Trigger Tool for measuring adverse events. IHI Innovation Series. Institute for Healthcare Improvement: Cambridge (MA); 2007.
• [3]Woloshynowych M, Neale G, Vincent C: Case record review of adverse events: a new approach. Qual Saf Health Care 2003 Dec, 12(6):411-415.
• [4]De Wet C, Bowie P: A preliminary study to develop and test a global trigger tool to identify undetected error and patient harm in primary care records. Postgrad Med J 2009, 85:176-180.
• [5]Bowie P, Halley L, Gillies J, Houston N, de Wet C: Searching primary care records for predefined triggers may expose latent risks and adverse events. Clinical Risk 2012, 18(January):13-18.
• [6]Health Foundation. Safety Improvement in Primary Care. London: 'The Health Foundation; Available at: http://www.health.org.uk/news-and-events/newsletter/safety-improvement-in-primary-care/ webcite [Accessed 2nd January 2013]
• [7]The Scottish Government: Delivering quality in primary care national action plan: implementing the Healthcare Quality Strategy for NHS Scotland. Edinburgh: The Scottish Government; 2010:1-18.
• [8]Executive S: NHS Education for Scotland, RCGP (Scotland) & BMA (Scotland). GP appraisal scheme: a brief guide. Scottish Executive: Edinburgh; 2003.
• [9]General Medical Council: Good Medical Practice. London: GMC; 2011:1-24.
• [10]World Health Organization: WHO Patient Safety Curriculum Guide for Medical Schools Part A: Teacher’s guide. Geneva: WHO Press; 2011:1-63.
• [11]Academy of Royal Medical Colleges, Royal College of Surgeons of Edinburgh and the NHS Institute for Innovation and Improvement: Patient Safety and Improvement Guidance for Postgraduate Medical Education. 2012. Available at: http://www.institute.nhs.uk/safer_care/safer_care/patient_safety_and_improvement_guidance_for_postgraduate_medical_education.html webcite. Accessed 01/01, 2013
• [12]Royal College of General Practitioners. RCGP Curriculum 2010, Statement 2.02: The contextual statement on Patient Safety and Quality of Care. London: RCGP; 2012:1-20.
• [13]Jaques H: RCGP wins bid to extend GP training to four years. 2012. Available at: http://careers.bmj.com/careers/advice/view-article.html?id=20007125 webcite. Accessed 01/01/2013, 2013
• [14]National Patient Safety Agency: What is a patient safety incident?. Available at: http://www.npsa.nhs.uk/nrls/reporting/what-is-a-patient-safety-incident/ webcite [Last accessed 2nd Janaury 2013]
• [15]Bowie P, Cooke S, Lo P, McKay J, Lough M: The assessment of criterion audit cycles by external peer review – when is an audit not an audit? J Eval Clin Pract 2007, 13(3):352-357.
• [16]McKay J, Bowie P, Lough M: Variations in the ability of general medical practitioners in applying two methods of clinical audit: a five-year study of assessment by peer review. J Eval Clin Pract 2006, 12(6):622-629.
• [17]McKay J, Bowie P, Murray L, Lough M: Levels of agreement on the grading, analysis and reporting of significant events by general practitioners: a cross-sectional study. Qual Saf Health Care 2008, 17(5):339-345.
• [18]Zwart DLM, Heddema WS, Vermeulen MI, van Rensen ELJ, Verheij TJM, Kalkman CJ: Lessons learnt from incidents reported by post graduate trainees in Dutch general practice: A prospective cohort study. BMJ Qual Saf 2011, 20:857-862.
• [19]Apekey TA, McSorley G, Tilling M, Siriwardena AN: Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice. J Eval Clin Pract 2011, 17(2):311-318.