AOTW: The Risk of Admission

Posted on: June 1, 2015, by :

Super interesting article with a CNCM first author (Dr. Stockwell of the PICU)!

A Trigger Tool to Detect Harm in Pediatric Inpatient Settings

The authors developed a novel pediatric trigger tool to determine rates of harm in hospitalized patients.  The tool searched the medical record for high risk words, phrases or orders (for example, naloxone was a high risk word for an iatrogenic narcotic overdose).  These triggers then prompted a manual review of the chart for harm.

The group found that 24.3% of patients had at least 1 documented harm, far above the 8-10% that is typically captured by voluntary reporting.

I found this article pertinent to our group for two reasons.  One, it reinforces what I think we already know, that being admitted is not the “benign” option and that there are risks to staying in the hospital.  Two, it was a novel approach to identifying safety issues.  Though this trigger tool was not geared toward the emergency department, the development of ED specific triggers (development of hypotension, contaminant blood cultures etcetera) may not be far off.

Happy Reading!

1 thought on “AOTW: The Risk of Admission


  1. We actually use a couple triggers in the ED. Return within 72 hours with admission is a trigger for review. Likewise transfer within 12 hours to PICU after admission to the floor. Both of these have low PPV, approximately 5-10%, so not very efficient. If a Fellow is interested in a research project, I would like to develop a trigger based on change in diagnosis after admission. So if the ED diagnosis pneumonia, for example, and the child is admitted and is discharged with a diagnosis of appendicitis, that would trigger a review. The PECARN Diagnosis Classification System could be used to identify these.

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