ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Policy
This article is part of the Research TopicChanging Healthcare through Innovation in Clinical Management and Healthcare Policy Strategies: Focus on Quality Improvement for the PatientView all 15 articles
Adverse Events Identified by a Trigger Tool as Indicators of Patient Safety and Safety Management in a Medical Department
Provisionally accepted
- 1Sevilla University, Seville, Spain
- 2Unidade Local de Saude do Algarve, Faro, Portugal
- 3Universidad de Sevilla Departamento de Enfermeria, Seville, Spain
- 4Instituto Politecnico de Lisboa Escola Superior de Tecnologia da Saude de Lisboa, Lisbon, Portugal
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Background: Adverse events (AEs) in hospital settings pose a significant threat to patient safety, particularly in patients with multiple comorbidities. Systematic detection tools, such as the Global Trigger Tool, have proven to be more sensitive than traditional voluntary reporting systems in identifying AEs. Objective: This study analyzes the prevalence, characteristics, and factors associated with the occurrence of AEs in an internal medicine department, focusing on patients with multiple morbidities, using a combined approach that integrates the European Portuguese version of the Global Trigger Tool (GTT-PT) and a voluntary reporting system. Methods: This observational, retrospective, exploratory study was conducted in four internal medicine departments at a Portuguese hospital center. A total of 360 randomly selected clinical records were included in this study. AEs were identified using the GTT-PT and by analyzing voluntary incident reports. Sociodemographic and clinical variables were analyzed using binary logistic regression. Results: A total of 718 AEs were identified, of which 564 (78.6%) occurred during hospitalization. Most events were of moderate severity (categories E and F in the Institute for Healthcare Improvement classification). Length of hospital stay was the main predictor of AEs occurrence (odds ratio [OR] range 1.011–1.173). The use of a nasogastric tube was also significantly associated with increased AE risk (OR = 6.693). The GTT-PT detected significantly more events than the voluntary reporting system. Conclusion: The combined use of the GTT-PT and voluntary reporting systems is highly effective in detecting AEs in internal medicine settings. Length of hospital stay and use of invasive devices are key factors associated with AE occurrence. These findings underscore the importance of institutional policies that support a non-punitive safety culture and encourage the systematic integration of proactive monitoring methodologies into clinical practice.
Keywords: Global Trigger Tool, Medical Errors, Patient Safety, adverse events, Safety Management
Received: 23 Sep 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Pierdevara, Galvez and Eiras. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ludmila Pierdevara
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