Assessment of a Geriatric Hip Fracture Program Analysis of Harmful Adverse Events Using the Global Trigger Tool Travis D. Blood, MD, Matthew E. Deren, MD, Avi D. Goodman, MD, Roman A. Hayda, MD, and Peter G. Trafton, MD Investigation performed at the Department of Orthopedics, Brown University, Providence, Rhode Island Background: The purpose of this study was to assess the impact of adding a geriatric comanagement program to the care of geriatric patients with a hip fracture at our hospital. The Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) was used to follow the frequency and severity of adverse events occurring in hospitalized patients and to examine the effectiveness of a comanagement program (the Geriatric Hip Fracture Program [GHFP]). Methods: Data were collected for patients treated for a hip fracture from 2010 to 2014, which was 1 year prior to (October 2010 to September 2011) and 2 years after the implementation of the GHFP, and were grouped into 3-month intervals for analysis. The patients treated prior to the implementation of the GHFP were compared with those treated following the implementation of the program. The frequency and severity of adverse events were collected using the GTT. Results: There were 75.9 patients with an adverse event and 160.7 adverse events per 100 admissions. After the institution of the GHFP, there was a significant decrease in the number of patients with adverse events and the number of adverse events per 100 admissions over time. The rate of adverse events decreased by 12% per year when acute blood loss anemia was excluded. Similarly, the number of adverse events (excluding blood loss anemia) decreased signi ficantly over time, from 128.7 per 100 admissions before the GHFP to 34.2 in the last quarter. Multivariable analysis (excluding acute blood loss anemia) demonstrated a trend toward a decreased likelihood of a patient experiencing an adverse event after the institution of the GHFP as well as a trend toward a decrease in the number of adverse events per patient. The length of the hospital stay was signi ficantly shorter after the im- plementation of the GHFP. Conclusions: The implementation of the GHFP reduced the number of adverse events over time. Increasing age and the Carlson Comorbidity Index (CCI) were predictors of adverse events, while only age was a predictor of readmissions and CCI was a predictor of death in our study. The implementation of the GHFP has played an important role at our institution in quantifying the decrease in adverse events over a 2-year period, and we believe that it is essential for improving care of geriatric patients with a hip fracture. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. I n the United States, >300,000 adults over the age of 65 years are admitted to a hospital each year for a hip fracture 1 . Elderly patients with a hip fracture often have multiple comorbidities, increasing the risk of adverse events. Inpatient mortality following hip fractures has been estimated to be between 4% and 13%, with a 1-year mortality rate between 12.7% and 24.5% 2-4 . Aharonoff et al. reported that ‡1 in- hospital postoperative complication was predictive of mor- tality 4 . Reducing the rate of in-hospital adverse events to decrease hip fracture morbidity and mortality is a priority. Geriatric hip fracture programs have emerged with the goal of coordinating care between geriatricians and/or internal medicine physicians and orthopaedic surgeons 5-7 . These models have been shown to decrease the length of the hospital stay, extraneous testing, and specialist consultations, resulting in lower costs 7 . Substantial decreases in in-hospital mortality and complications have also been reported 6 . As a result of increasing interest, various methods have been developed for measuring adverse events in hospitalized patients 8-10 . One method of ana- lyzing these events is the Global Trigger Tool (GTT), established Disclosure: This study was funded by the Lifespan Risk Services Loss Prevention Grant. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work ( http://links.lww.com/JBJS/F146). 704 COPYRIGHT Ó 2019 BY THE J OURNAL OF BONE AND J OINT SURGERY,I NCORPORATED J Bone Joint Surg Am. 2019;101:704-9 d http://dx.doi.org/10.2106/JBJS.18.00376