Introduction

The management of the clinical risk aimed to ensure patient safety is a priority of healthcare organizations. Ensuring safety care is a goal inherent in the concept of adequacy of performance, which must be safe, effective, efficient and tailor-made to the needs and expectations of citizens.

It is illusory and deceptive to think that the disclosure of good practices can ensure, on its own, an effective improvement in patient safety.

It is also necessary to consider the structural, technological, plant and organizational context in which a specific performance is provided, the skills and abilities of the involved actors and, as a whole, the resources needed to ensure an appropriate healthcare

The health organizations have developed proactive error detection tools as FMEA and FMECA, as well as reactive as incident reporting, audit, and RCA.

Hospitals, however, are always looking for more and more effective methodologies to identify events that cause patients harm and to control if the corrective actions that are being introduced are improving the safety of treatment processes.

The Global Trigger Tool wants to reply on the one hand to the demand of improving the acquisition of the information about errors and adverse events occurring in the hospital and, on the other to check the effectiveness of the improvement actions introduced following detection of the same ones.

The Global Trigger Tool model is not the definitive solution to the problems of risk governance in health organizations, but wants to be further progress in the development of clinical risk management programs, which have long been initiated by the Sicilian Region, and with which it intend to integrate.

The Global Trigger Tool methodology

The methodology, was developed by the Institute for Healthcare Improvement, Cambridge, Massachusetts, USA and essentially consists in the retrospective review of a random sample of clinical folders for the search of “triggers” (or clues) that, if present, may indicate the possibility of an adverse event

The Global Trigger Tool methodology provides a detection protocol that defines the audit team composition, clinical folder sampling modes, revision process, how to detect an adverse event, how to process and analyze data.

The project of the Sicilian Region

The application of the Global Trigger Tool methodology in the hospitals of the Sicilian Region is a project funded by the Ministry of Health in the context of national health plan goals.

The project of the Sicilian region started at the end of 2013, involving all the hospitals of the healthcare regional system, about 100 UOCs of the various disciplines, about 300 doctors, nurses and obstetricians who are part of the audit team, whom have been formed to the utilization of this methodology.

To date, about 7,000 clinical records have been analyzed, about 900 adverse events have been identified and appropriate improvement actions have been undertaken whose effectiveness is currently being evaluated. The methodology has proven to be effective in involving operators in the issues of patient safety, in detecting adverse events, and in verifying the effectiveness of the improvement actions introduced following their detection, representing the most innovative aspect of the system.

The workshop

The “Global Trigger Tool: a Project for the Sicilian Region” workshop has a threefold goal: to foster the safety culture among healthcare professionals, to learn from authoritative experiences the “Global Trigger Tool”  tools and to present the results of the regional project .

According to the dominant and hegemonic vision of medicine, largely represented by the emphasis on the role of technologies and resources, which neglects the value of culture, such goals may appear secondary, marginal, and certainly not effective. However, we are firmly convinced that without culture there is neither progress nor innovation; there is no safety or quality of care.

The hope is that this event and the initiatives that will be carried out in the near future can increase awareness of the role that each, regional government, hospital’s managers and healthcare professionals carries out in their daily work to ensure patient care more and more securely .

The aspects of the Global Trigger Tool methodology will be discussed in relation to care-related infections, adverse events associated with drug therapy, initiatives undertaken by some Sicilian hospitals in contrast to risk, and the correlation between guidelines and professional accountability will be debated Experiences of other European countries.

Program

1st session SALA A 10.00-11.00

The GTT methodology: an European experiences to detect adverse events

Chairman:       Rosario Cunsolo

Medical Director, “S. Vincenzo” Hospital, Taormina (ME), Italia

Moderators:  Giuseppe Carpinteri

Director of Emergency Department Unit, Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, Catania – Italia

Giovanna Russo

Associate Professor of Pediatrics , Università degli Studi di Catania – Italia

 

Speakers:         Fernando Vazquez

Hospital Universitario Central de Asturias, Oviedo – Spain

Strenghts and weaknesses of the Global Trigger  Tool

Maria Unbeck

Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockolm – Sweden

Validity and reliability concerns to be aware of when using Trigger Tool

 

2nd session SALA A 11.30-13.00

The GTT methodology  in surgical and obstetric area

 

Moderators:  Giuseppe Drago

Medical Director, ASP Ragusa – Italia

Giuseppe Giammanco

General Manager , ASP Catania – Italy

Speaker:           Peter Lachman

CEO ISQua, Dublin – Ireland

Learning and improving – what it takes to be safe

Round table

Maria Antonetta Campo, Antonio Capodicasa, Emilia Fisicaro

 

2nd session SALA B 11.30-13.00

The GTT methodology  in intensive care and internal medicine area

 

Moderators:  Stefania Stefani

Full Professor of Microbiology, Università degli Studi di Catania – Italia

Filomena Autieri

Manager of Quality and Clinical Risk Unit, Azienda Ospedaliero-Universitaria “Careggi”, Firenze – Italia

Speaker:           Óscar Guzmán Ruiz

Centre Hospitalier Epicura ASBL – Belgium

The GTT methodology and the correlated infection to the assistance

Round table

Carmelo Davide Busacca, Stellario Chiovè, Tommaso Mannone

 

3rd session SALA A 13.00-14.30

Round table

Guidelines and professional liability in Europe

 

Moderators:  Giuseppe Ettore

Director of Gynaecology and Obstetrics Unit ,  ARNAS “Garibaldi”, Catania – Italia

Gianfranco Jorizzo

Ministry of Healthcare, Italy

Speaker:           Vincenzo Parrinello

Manager of Quality Unit , Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, Catania – Italia

Fernando Vazquez

Hospital Universitario Central de Asturias, Oviedo – Spain

Maria Unbeck

Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockolm – Sweden

Peter Lachman

CEO ISQua, Dublin – Ireland

Óscar Guzmán Ruiz

Centre Hospitalier Epicura ASBL – Belgium