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4CPS-021 Performance of multiple trigger tools in identifying medication-related hospital readmissions
  1. A Singh1,
  2. N Lips2,
  3. N Lips,
  4. D Weir3,
  5. F Karapinar – Carkit1,4
  1. 1Olvg Hospital, Department of Clinical Pharmacy, Amsterdam, The Netherlands
  2. 2Olvg Hospital, Department of Internal Medicine, Amsterdam, The Netherlands
  3. 3Utrecht Institute for Pharmaceutical Sciences- Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, The Netherlands
  4. 4MUMC+, Department of Clinical Pharmacy and Toxicology, Maastricht, The Netherlands


Background and Importance The Dutch polypharmacy guideline recommends using a trigger tool to identify medication-related hospital (re)admissions. Many trigger tools exist for this purpose. Yet, the effectiveness of these trigger tools and clinical applicability remains uncertain.

Aim and Objectives The aim of this study is to evaluate the performance of trigger tools in identifying medication-related readmissions (MRRs).

Material and Methods In a single-centre cross-sectional study, data was analysed from a previous study assessing 1120 readmissions. In this prior study, a panel of physicians and pharmacists retrospectively assessed readmissions as medication-related (n=181), including preventability.

This current study employed four trigger tools (START-STOPP criteria, OPERAM, ADR-tool, and QUADRAT*) on clinically adjudicated MRRs. The START-STOPP criteria focus on under- and overtreatment, OPERAM on multiple causes, while ADR and QUADRAT tools focus on side effects. The tools include explicit triggers (medication + symptom, e.g., diuretics and dehydration) and implicit triggers (general triggers requiring extensive reviewer knowledge, e.g., avoiding overtreatment). The trigger tools were applied to clinically adjudicated MRRs in duplicate. The primary outcome was each tool’s performance in identifying MRRs. Secondary outcomes included assessing the performances of these tools in identifying MRRs based on the potential preventability and age of patients (most tools are developed for patients ≥70 years). Descriptive data-analysis was used.

Results Of 181 MRRs, 159 (88%) were regarded potentially preventable by the panel. Among the 181 MRRs, the OPERAM trigger tool identified 92% of MRRs (62% explicit and 30% implicit triggers), while the QUADRAT, ADR and START-STOPP criteria respectively identified 76%, 51% and 7% of MRRs. The tools were more effective in identifying non-preventable MRRs. The tools missed triggers regarding transition in care errors, non-adherence or sick day rules. The trigger tools identified an equal proportion of MRRs for patients below and above 70 years.

Conclusion and Relevance Multiple trigger tools were applied to real-life patient data. START-STOPP criteria, ADR-tool, and QUADRAT were unsuccessful in identifying MRRs in this study. OPERAM performed the best but included many implicit triggers necessitating substantial reviewer knowledge to assess MRRs. Consequently, in daily clinical practice, OPERAM is not easy to apply as a quick screening tool but could be a good tool for research purposes.

Conflict of Interest No conflict of interest.

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