Addressing logistical challenges in evaluating a national system for measuring adverse events

Introduction: All Norwegian hospital trusts have measured adverse event rates since 2011 using the Global Trigger Tool (GTT). As they have different GTT teams, results have not been compared between them and interrater reliability has not been established. All Norwegian GTT teams undergo the same national training, which prompted an interest in exploring the feasibility of comparing results between hospital trusts.
Objective: To organize a research project testing interrater reliability between 20 GTT teams in 13 hospital trusts and one hospital.
Methods: Sending medical records securely between hospital trusts was a difficult challenge. Due to privacy regulations, accessing electronic medical records across hospital trusts was not possible. The research project limited the inclusion of data from the medical records to no more than 30 days prior to and after hospital admission. This made the medical record extraction more time consuming. Two hospital trusts used a robot for extracting medical records. The Regional committee for medical and health research ethics (REK) consented to the research project.
Results: Digital mail for public enterprises (DPE) was recently developed in Norway to send and receive electronic post securely. This became the solution for distributing the medical records, and required that several of the hospital trusts had to implement the DPE solution. 920 medical records were converted to PDFs by and distributed from 14 GTT teams, to between one and four other GTT teams involved in the project. The National Archives of Norway approved the required records retention and disposal plan, which detailed the disposal of all PDF versions of the medical records throughout the workflow.
Conclusion: The logistical challenges and solutions associated with securely sending 920 medical records between different hospital trusts nationwide, makes the experiences from this research project relevant for other national settings that might wish to take a similar approach.