In a study comparing the performance of multiple trigger tools in identifying medication-related hospital readmissions, the OPERAM tool performed the best, identifying the highest number of both the total medication-related (re)admissions (MRRs) and potential preventable MRRs.
Trigger tools are used to identify and measure adverse events over time and recognise MRRs. This study compared the accuracy of trigger tools to clinical adjudication.
The researchers conducted a secondary analysis of data collected from patients readmitted within 30 days to seven different departments of a teaching hospital. In the original study, clinicians assessed 1,111 readmissions to determine whether they were MMRs and potentially preventable. This new study applied four trigger tools to the data to measure both explicit (identifying the event and the associated medication) and implicit (requiring clinical knowledge) triggers and determine the ability of each tool to accurately calculate the number of MMRs compared to the original data.
All four trigger tools tested (OPERAM, STOPP/START criteria, ADR-tool, and QUADRAT) identified non-preventable MRRs more often than preventable ones, and all tools missed transition in care errors.
Of the total readmissions, 181 were medication-related, of which 40% (n=72) were potentially preventable. The OPERAM tool identified the highest total MRRs (92%) and the highest potentially preventable MRRs (82%), but only 62% of the MMRs were identified through explicit triggers.
The STOPP/START criteria identified 23 (13%, 7% through explicit triggers), the ADR tool identified 51 (28%, all explicit triggers), and the QUADRAT tool identified 76 (42%; all explicit triggers) MRRs.
OPERAM was the most effective in identifying the highest proportion of preventable MRRs and stood out because it included a trigger for the suspicion of non-adherence by healthcare professionals. However, its use is limited by the need for expert clinicians to interpret the implicit trigger to use it properly, the researchers concluded.
The study highlighted that as prescribing errors, transition errors and non-adherence often occur around hospital discharge, interventions in the hospital and post-discharge settings to follow-up on patients are imperative.
The researchers suggested that future studies should assess the practicality of implementing OPERAM in daily practice.
Reference
Lips, N et al. Comparing the performance of multiple trigger tools in identifying medication-related hospital readmissions. J Am Geriatr Soc. 2024; Oct 9: DOI: 10.1111/jgs.19216.
