{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T01:14:56Z","timestamp":1768266896384,"version":"3.49.0"},"reference-count":37,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,2,27]],"date-time":"2022-02-27T00:00:00Z","timestamp":1645920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Adverse events (AEs)\u2014healthcare caused events leading to patient harm or even death\u2014are common in healthcare. Although it is a frequently investigated topic, systematic knowledge on this phenomenon in stroke patients is limited. To determine cumulative incidence of no-harm incidents and AEs, including their severity and preventability, a cohort study using trigger tool methodology for retrospective record review was designed. The study was carried out in a stroke center at a university hospital in the German speaking part of Switzerland. Electronic records from 150 randomly selected patient admissions for transient ischemic attack (TIA) or ischemic stroke, with or without acute recanalization therapy, were used. In total, 170 events (108 AEs and 62 no-harm incidents) were identified, affecting 83 patients (55.3%; 95% CI 47 to 63.4), corresponding to an event rate of 113 events\/100 admissions or 142 events\/1000 patient days. The three most frequent AEs were ischemic strokes (n = 12, 7.1%), urinary tract infections (n = 11, 6.5%) and phlebitis (n = 10, 5.9%). The most frequent no-harm incidents were medication events (n = 37, 21.8%). Preventability ranged from 12.5% for allergic reactions to 100% for medication events and pressure ulcers. Most of the events found (142; 83.5%; 95% CI 76.9 to 88.6) occurred throughout the whole stroke care. The remaining 28 events (16.5%; 95% CI 11.4 to 23.1) were detected during stroke care but were related to care outside the stroke pathway. Trigger tool methodology allows detection of AEs and no-harm incidents, showing a frequent occurrence of both event types in stroke and TIA patients. Further investigations into events\u2019 relationships with organizational systems and processes will be needed, first to achieve a better understanding of these events\u2019 underlying mechanisms and risk factors, then to determine efforts needed to improve patient safety.<\/jats:p>","DOI":"10.3390\/ijerph19052796","type":"journal-article","created":{"date-parts":[[2022,2,27]],"date-time":"2022-02-27T20:47:17Z","timestamp":1645994837000},"page":"2796","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Occurrence of No-Harm Incidents and Adverse Events in Hospitalized Patients with Ischemic Stroke or TIA: A Cohort Study Using Trigger Tool Methodology"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0620-8553","authenticated-orcid":false,"given":"Bartosch","family":"Nowak","sequence":"first","affiliation":[{"name":"Department Head Organs, Spine- and Neuromedicine, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4804-1656","authenticated-orcid":false,"given":"Ren\u00e9","family":"Schwendimann","sequence":"additional","affiliation":[{"name":"Patient Safety Office, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Institute of Nursing Science, University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Lyrer","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, University Hospital and University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leo H.","family":"Bonati","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, University Hospital and University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gian Marco","family":"De Marchis","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, University Hospital and University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nils","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, University Hospital and University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8844-4903","authenticated-orcid":false,"given":"Franziska","family":"Z\u00fa\u00f1iga","sequence":"additional","affiliation":[{"name":"Institute of Nursing Science, University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lili","family":"Saar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Universit\u00e4tsklinik Freiburg, 79106 Freiburg im Breisgau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5090-0352","authenticated-orcid":false,"given":"Maria","family":"Unbeck","sequence":"additional","affiliation":[{"name":"School of Health and Welfare, Dalarna University, 79131 Falun, Sweden"},{"name":"Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2349-7219","authenticated-orcid":false,"given":"Michael","family":"Simon","sequence":"additional","affiliation":[{"name":"Institute of Nursing Science, University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Schwendimann, R., Blatter, C., Dhaini, S., Simon, M., and Ausserhofer, D. (2018). The occurrence, types, consequences and preventability of in-hospital adverse events\u2013a scoping review. BMC Health Serv. Res., 18.","DOI":"10.1186\/s12913-018-3335-z"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1136\/qshc.2007.023622","article-title":"The incidence and nature of in-hospital adverse events: A systematic review","volume":"17","author":"Ramrattan","year":"2008","journal-title":"Qual. Saf. Health Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/00063110-200504000-00005","article-title":"Adverse events and death in stroke patients admitted to the emergency department of a tertiary university hospital","volume":"12","author":"Lorenzi","year":"2005","journal-title":"Eur. J. Emerg. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1212\/WNL.0000000000004111","article-title":"Hospital safety among neurologic patients: A population-based cohort study of adverse events","volume":"89","author":"Sauro","year":"2017","journal-title":"Neurology"},{"key":"ref_5","unstructured":"Slawomirski, L., Auraaen, A., and Klazinga, N.S. (2017). The Economics of Patient Safety, OECD."},{"key":"ref_6","unstructured":"Griffin, F.A., and Raser, R.K. (2009). IHI Global Trigger Tool for Measuring Adverse Events, Institute for Healthcare Improvement."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1212\/01.wnl.0000254992.39919.2e","article-title":"The safety of hospital stroke care","volume":"68","author":"Holloway","year":"2007","journal-title":"Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/JNN.0000000000000247","article-title":"Multicenter Study of Adverse Events after Intravenous Tissue-Type Plasminogen Activator Treatment of Acute Ischemic Stroke","volume":"49","author":"Lightfoot","year":"2017","journal-title":"J. Neurosci. Nurs."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1136\/bmj.320.7237.768","article-title":"Human error: Models and management","volume":"320","author":"Reason","year":"2000","journal-title":"BMJ (Clin. Res. Ed.)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1093\/intqhc\/mzv063","article-title":"Resilient health care: Turning patient safety on its head","volume":"27","author":"Braithwaite","year":"2015","journal-title":"Int. J. Qual. Health Care J. Int. Soc. Qual. Health Care"},{"key":"ref_11","unstructured":"WHO (2009). Conceptual Framework for the International Classification for Patient Safety, World Health Organization."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lindblad, M., Unbeck, M., Nilsson, L., Schildmeijer, K., and Ekstedt, M. (2020). Identifying no-harm incidents in home healthcare: A cohort study using trigger tool methodology. BMC Health Serv. Res., 20.","DOI":"10.1186\/s12913-020-05139-z"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Schildmeijer, K., Unbeck, M., Muren, O., Perk, J., Pukk Harenstam, K., and Nilsson, L. (2013). Retrospective record review in proactive patient safety work-identification of no-harm incidents. BMC Health Serv. Res., 13.","DOI":"10.1186\/1472-6963-13-282"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1377\/hlthaff.2011.0190","article-title":"\u2018Global trigger tool\u2019 shows that adverse events in hospitals may be ten times greater than previously measured","volume":"30","author":"Classen","year":"2011","journal-title":"Health Aff. (Proj. Hope)"},{"key":"ref_15","first-page":"640","article-title":"The application of the Global Trigger Tool: A systematic review","volume":"28","author":"Hibbert","year":"2016","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/jep.12075","article-title":"Characteristics associated with the occurrence of adverse events: A retrospective medical record review using the Global Trigger Tool in a fully digitalized tertiary teaching hospital in Korea","volume":"20","author":"Hwang","year":"2014","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3233\/JRS-150639","article-title":"Application of the IHI Global Trigger Tool in measuring the adverse event rate in a Turkish healthcare setting","volume":"27","author":"Kurutkan","year":"2015","journal-title":"Int. J. Risk Saf. Med."},{"key":"ref_18","first-page":"w20149","article-title":"Describing adverse events in medical inpatients using the Global Trigger Tool","volume":"149","author":"Grossmann","year":"2019","journal-title":"Swiss Med. Wkly."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"103473","DOI":"10.1016\/j.ijnurstu.2019.103473","article-title":"Exploring the incidence and nature of nursing-sensitive orthopaedic adverse events: A multicenter cohort study using Global Trigger Tool","volume":"102","author":"Hommel","year":"2020","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1093\/intqhc\/mzu072","article-title":"Does adding an appended oncology module to the Global Trigger Tool increase its value?","volume":"26","author":"Mattsson","year":"2014","journal-title":"Int. J. Qual. Health Care J. Int. Soc. Qual. Health Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e160","DOI":"10.1002\/hsr2.160","article-title":"Describing adverse events in Swiss hospitalized oncology patients using the Global Trigger Tool","volume":"3","author":"Gerber","year":"2020","journal-title":"Health Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Unbeck, M., Lindemalm, S., Nydert, P., Ygge, B.M., Nylen, U., Berglund, C., and Harenstam, K.P. (2014). Validation of triggers and development of a pediatric trigger tool to identify adverse events. BMC Health Serv. Res., 14.","DOI":"10.1186\/s12913-014-0655-5"},{"key":"ref_23","first-page":"256","article-title":"Prevalence of no harm incidents and adverse events in a surgical clinic","volume":"26","author":"Bezerra","year":"2013","journal-title":"Acta Paul. Enferm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1136\/bmjqs-2017-006755","article-title":"Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare","volume":"27","author":"Lindblad","year":"2018","journal-title":"BMJ Qual. Saf."},{"key":"ref_25","unstructured":"Team, R. (2019, May 12). RStudio: Integrated Development for R. RStudio. Available online: http:\/\/www.rstudio.com\/."},{"key":"ref_26","unstructured":"Swedish Ministry of Health and Social Welfare (2020, May 02). Patient Safety Act, (In Swedish: Patients\u00e4kerhetslagen SFS 2010:659), Available online: https:\/\/www.riksdagen.se\/sv\/dokument-lagar\/dokument\/svensk-forfattningssamling\/patientsakerhetslag-2010659_sfs-2010-659."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e019267","DOI":"10.1136\/bmjopen-2017-019267","article-title":"Adverse events in patients in home healthcare: A retrospective record review using trigger tool methodology","volume":"8","author":"Schildmeijer","year":"2018","journal-title":"BMJ Open"},{"key":"ref_28","first-page":"2611","article-title":"Severity-Indexed, Incident Report-Based Medication Error-Reporting Program","volume":"48","author":"Hartwig","year":"1992","journal-title":"Am. J. Hosp. Pharm."},{"key":"ref_29","first-page":"168","article-title":"Ein Werkzeug f\u00fcr die Qualit\u00e4tssicherung und Forschung","volume":"16","author":"Bonati","year":"2016","journal-title":"Schweiz. Med.-Forum"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1177\/003693305700200504","article-title":"Cerebral vascular accidents in patients over the age of 60. II. Prognosis","volume":"2","author":"Rankin","year":"1957","journal-title":"Scott. Med. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1161\/01.STR.0000258355.23810.c6","article-title":"Outcomes validity and reliability of the modified Rankin scale: Implications for stroke clinical trials: A literature review and synthesis","volume":"38","author":"Banks","year":"2007","journal-title":"Stroke"},{"key":"ref_32","unstructured":"Microsoft (2019, May 05). Excel Office 365 MSO ProPlus. Available online: https:\/\/products.office.com\/de-de\/excel."},{"key":"ref_33","first-page":"l4185","article-title":"Prevalence, severity, and nature of preventable patient harm across medical care settings: Systematic review and meta-analysis","volume":"366","author":"Panagioti","year":"2019","journal-title":"BMJ (Clin. Res. Ed.)"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1161\/01.STR.32.4.891","article-title":"The ICH Score","volume":"32","author":"Hemphill","year":"2001","journal-title":"Stroke"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1046\/j.1525-1497.2003.20147.x","article-title":"Measuring errors and adverse events in health care","volume":"18","author":"Thomas","year":"2003","journal-title":"J. Gen. Intern. Med."},{"key":"ref_36","unstructured":"Institute for Healthcare Improvement (2018, June 23). IHI Global Trigger Tool Training Resources. Available online: http:\/\/www.ihi.org\/resources\/Pages\/Tools\/IHIGlobalTriggerToolTrainingResources.aspx."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1754-9493-7-10","article-title":"Is detection of adverse events affected by record review methodology? an evaluation of the \u201cHarvard Medical Practice Study\u201d method and the \u201cGlobal Trigger Tool\u201d","volume":"7","author":"Unbeck","year":"2013","journal-title":"Patient Saf. Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2796\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:28:55Z","timestamp":1760135335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2796"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,27]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19052796"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19052796","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,27]]}}}