Outpatient Triggers

The study reviewed outpatient records using 37 triggers derived from outpatient and medication/laboratory trigger sets. Inter-rater reliability for adverse event presence, severity, and preventability indicated substantial agreement. The five-or-more-medications trigger was common but had very low positive predictive value. Some triggers require patient contact or alternative surveillance because medical records alone did not identify them. Most frequently observed triggers tended to have low positive predictive value.