A Systematic Review of Methods for Medical Record Analysis to Detect Adverse Events in Hospitalized Patients

D.O. Klein*, R.J.M.W. Rennenberg, R.P. Koopmans, M.H. Prins

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


Objective In this systematic review, we evaluate 2 of the most used trigger tools according to the criteria of the World Health Organization for evaluating methods. Methods We searched Embase, PubMed, and Cochrane databases for studies (2000-2017). Studies were included if medical record review (MRR) was performed with either the Global Trigger Tool or the Harvard Medical Practice Study in a hospital population. Quality assessment was performed in duplicate. Fifty studies were included, and results were reported for every criterion separately. Results Medical record review reveals more adverse events (AEs) than any other method. However, at the same time, it detects different AEs. The costs of an AE were on average euro4296. Considerable efforts have been made worldwide in health care to improve safety and to reduce errors. These have resulted in some positive effects. The literature showed that MRR is focused on several domains of quality of care and seems suitable for both small and large cohorts. Furthermore, we found a moderate to substantial agreement for the presence of a trigger and a moderate to good agreement for the presence of an AE. Conclusions Medical record review with a trigger tool is a reasonably well-researched method for the evaluation of the medical records for AEs. However, looking at the World Health Organization criteria, much research is still lacking or of moderate quality. Especially for the cost of detecting AEs, valuable information is missing. Moreover, knowledge of how MRR changes quality and safety of care should be evaluated.
Original languageEnglish
Pages (from-to)E1234-E1240
Number of pages7
JournalJournal of Patient Safety
Issue number8
Publication statusPublished - 1 Dec 2021


  • trigger tool
  • adverse event
  • patient safety
  • Global Trigger Tool
  • hospital
  • CARE
  • COST
  • HARM

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