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Comparing the Outcomes of Reporting and Trigger Tool Methods to Capture Adverse Events in the Emergency Department

Lee, Wen-Huei MD*; Zhang, Ewai MD*; Chiang, Charng-Yen MD*; Yen, Yung-Lin MD*; Chen, Ling-Ling BSN, RN; Liu, Mei-Hsiu BSN, RN; Kung, Chia-Te MD*; Hung, Shih-Chiang MD*‡

doi: 10.1097/PTS.0000000000000341
Original Article: PDF Only

Background Little is known about which methods are best for detecting adverse events in the emergency department (ED).

Objectives This study compared the ability of trigger tool and reporting methods to capture adverse events in the ED and investigated the characteristics of the adverse events identified by each.

Methods This 1-year prospective observational cohort study evaluated a monitoring system that combined 2 reporting methods and 5 trigger tool methods to capture adverse events in the ED of an academic medical center. Measurement outcomes included the number, type, and physical impact of the captured adverse events.

Results Among 69,327 adult nontrauma ED visits, 285 adverse events were identified. Of these adverse events, 77.2% were identified using reporting methods, 26% using trigger tool methods, and 3.2% using both methods. Most patients (81.7%) incurred temporary, minor physical impacts. Of the adverse events that occurred, 86.7% were related to clinical performance. Compared with reporting methods, trigger tool methods had a lower positive predictive rate to identify adverse events (odds ratio [OR], 0.1; 95% confidence interval [CI], 0.09–0.16), a greater proportion of adverse events occurring during the preinterventation and postintervention phases (OR, 17.0; 95% CI, 8.48–34.16), and more cases of severe physical impact or death (OR, 5.4; 95% CI, 2.62–11.10).

Conclusions The reporting methods more effectively captured greater numbers of adverse events, whereas the adverse events captured by the trigger tool methods were more likely to be severe physical impacts. The combined use of the different methods had synergistic benefits for monitoring adverse events in the ED.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the Department of *Emergency Medicine and †Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; and ‡Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.

Correspondence: Shih-Chiang Hung, MD, Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dabi Rd, Niasung District, Kaohsiung City 83301, Taiwan (e-mail:

The authors disclose no conflict of interest.

Source of Funding: Granted by Chang Gung Research Program (No. CMRPG8B0931), Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

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