Institute for Healthcare Improvement18 Outpatient Adverse Event Trigger Explanations
| Trigger 1: new diagnosis of cancer | Treatment for cancer commonly requires surgery, chemotherapy, etc. This type of care has risks for adverse events related to the care, such as leukopenia from chemotherapy or surgical infection. Avoid wandering into the issue of omission, which can occur easily. For example, failure to do appropriate preventive measures and cancer diagnosis missed for a year is not an adverse event as defined in this tool because it is not an unintended consequence from care delivered. The tool is not meant to evaluate the appropriateness of care, but rather to determine if an adverse event did occur from the care which was delivered. |
| Trigger 2: nursing home placement | Determine if the placement was the result of an event, such as over sedation causing a fall and hip fracture or a surgical misadventure requiring long-term care. |
| Trigger 3: admission & discharge from hospital | Determine if the reason for admission was related to an event related to any health care interaction, either inpatient or outpatient. |
| Trigger 4: 2 or more consultants in a year of review | Multiple consultants can be the result of a medical misadventure. Look for unintended events from other care that required consultation with others afterwards. |
| Trigger 5: surgical procedure | Look for evidence of pulmonary embolism, deep vein thrombosis, wound dehiscence, infection, hemorrhage, hematoma, etc.—any of the unintended events that can occur from surgery either while the patient was in the hospital or after discharge. |
| Trigger 6: ED visit | Look for the reason for the visit, specifically for an adverse event related to other care that required ED care or events related to the ED visit. |
| Trigger 7: Greater than 5 medications | Evidence exists that patients taking greater than 5 medications have a high incidence of adverse medication events. Look for drug-drug interactions, particularly over sedation or overmedication, and development of toxicity. |
| Trigger 8: physician change | Look for an abrupt change from a mid-level provider to a physician or out of network referral. Was there an abrupt change in the physician in charge? What might that reason be? Look for adverse events. |
| Trigger 9: complaint letter | Look to see if the complaint related to an event (i.e., request for the waiver of co-payment, payment or concern about quality of care). |
| Trigger 10: >3 nursing calls in 1 week | Calls might all be related to one event. |
| Trigger 11: Abnormal Lab Value | Patients with results outside of range have greater risk of experiencing an adverse event. The lab value itself is only a trigger, so look for evidence of harm. Pay particular attention to lab values related to high-risk medications, such as INR >6 or Glucose <50. |
ED, emergency department; INR, International normalized ratio.