PT  - JOURNAL ARTICLE
AU  - Tom Margham
AU  - Natalie Symes
AU  - Sally A Hull
TI  - Using the electronic health record to build a culture of practice safety: evaluating the implementation of trigger tools in one general practice
AID  - 10.3399/bjgp18X695489
DP  - 2018 Apr 01
TA  - British Journal of General Practice
PG  - e279--e285
VI  - 68
IP  - 669
4099  - http://bjgp.org/content/68/669/e279.short
4100  - http://bjgp.org/content/68/669/e279.full
SO  - Br J Gen Pract2018 Apr 01; 68
AB  - Background Identifying patients at risk of harm in general practice is challenging for busy clinicians. In UK primary care, trigger tools and case note reviews are mainly used to identify rates of harm in sample populations.Aim This study explores how adaptions to existing trigger tool methodology can identify patient safety events and engage clinicians in ongoing reflective work around safety.Design and setting Mixed-method quantitative and narrative evaluation using thematic analysis in a single East London training practice.Method The project team developed and tested five trigger searches, supported by Excel worksheets to guide the case review process. Project evaluation included summary statistics of completed worksheets and a qualitative review focused on ease of use, barriers to implementation, and perception of value to clinicians.Results Trigger searches identified 204 patients for GP review. Overall, 117 (57%) of cases were reviewed and 62 (53%) of these cases had patient safety events identified. These were usually incidents of omission, including failure to monitor or review. Key themes from interviews with practice members included the fact that GPs’ work is generally reactive and GPs welcomed an approach that identified patients who were ‘under the radar’ of safety. All GPs expressed concern that the tool might identify too many patients at risk of harm, placing further demands on their time.Conclusion Electronic trigger tools can identify patients for review in domains of clinical risk for primary care. The high yield of safety events engaged clinicians and provided validation of the need for routine safety checks.