Experiences with global trigger tool reviews in five Danish hospitals: an implementation study

Plessen, Christian von; Kodal, Anne Marie; Anhøj, Jacob

doi:10.1136/bmjopen-2012-001324

Cited by 52 publications

(43 citation statements)

References 21 publications

(22 reference statements)

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“…A recent Danish study showed that the method was initially interpreted differently at different hospitals 25. Small changes in methodology and a gradual development of skills could explain inter-rater disagreement between teams.…”

Section: Discussionmentioning

confidence: 99%

Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members

et al. 2013

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ObjectivesThe aim was to describe the strengths and weaknesses, from team member perspectives, of working with the Global Trigger Tool (GTT) method of retrospective record review to identify adverse events causing patient harm.DesignA qualitative, descriptive approach with focus group interviews using content analysis.Setting5 Swedish hospitals in 2011.Participants5 GTT teams, with 5 physicians and 11 registered nurses.Intervention5 focus group interviews were carried out with the five teams. Interviews were taped and transcribed verbatim.Results8 categories emerged relating to the strengths and weaknesses of the GTT method. The categories found were: Usefulness of the GTT, Application of the GTT, Triggers, Preventability of harm, Team composition, Team tasks, Team members’ knowledge development and Documentation. Gradually, changes in the methodology were made by the teams, for example, the teams reported how the registered nurses divided up the charts into two sets, each being read respectively. The teams described the method as important and well functioning. Not only the most important, but also the most difficult, was the task of bringing the results back to the clinic. The teams found it easier to discuss findings at their own clinics.ConclusionsThe GTT method functions well for identifying adverse events and is strengthened by its adaptability to different specialties. However, small, gradual methodological changes together with continuingly developed expertise and adaption to looking at harm from a patient's perspective may contribute to large differences in assessment over time.

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Section: Discussionmentioning

confidence: 99%

Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members

et al. 2013

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“…The GTT was used as part of a measurement strategy in both the Health Foundation's Safer Patients Initiative and the 1000 Lives Campaign, 11 and with some success. However, the experience of NHS Wales Hospitals using the IHI GTT was similar to that reported in Danish hospitals, 47 and there was significant variation in rates and experience in its use across hospital sites. As Wales was committed to ongoing harm measurement and monitoring, we set out to compare the methodological approaches in order to identify the optimal approach to quantify the nature and extent of AEs occurring across NHS Wales's acute hospitals over time and ensure the robustness of our current approach.…”

Section: Discussionmentioning

confidence: 83%

“…In a European context, von Plessen et al 47 examined rates of harm using the GTT in five Danish hospitals and reported significant variation between hospitals ranging between 18% and 33%. However, in another, more regulated, smaller study comparing the identification of AEs in 350 orthopaedic admissions in Sweden, the Harvard method detected 155 AEs, compared with 137 events detected by the GTT.…”

Section: A Comparative Analysis Of the Global Trigger Tool And The Hamentioning

confidence: 99%

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Mayor

Baines

Vincent

et al. 2017

Health Serv Deliv Res

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Background, objectives and settingDespite global activity over the past 15 years to improve patient safety, the measurement of adverse events (AEs) remains challenging.ObjectivesWe aimed to obtain definitive longitudinal data on harm across NHS Wales and to compare the performance of the Global Trigger Tool (GTT) with the two-stage retrospective review process, using our findings to consolidate an approach to the ongoing surveillance of harm in Wales.Data sourcesEleven of the 13 major Welsh NHS hospitals.Review methodsThe two-stage retrospective review methodology was used to quantify harm across NHS Wales. In total, 4536 inpatient episodes were screened for AEs by research nurses. Records that were highly suggestive of AEs were further assessed by physicians. NHS-led teams undertook GTT reviews on the same case notes.ResultsAt least one AE was determined in 10.3% of episodes of care [95% confidence interval (CI) 9.4% to 11.2%] and 51.5% were preventable (95% CI 46.9% to 56.1%). The percentage of patients identified with AEs using the GTT methodology was lower, at 9.0% (95% CI 8.82% to 9.18%). Differences in AEs were evident across study sites. Methods were developed to profile the risk of AEs in individual organisations by producing signatures of harm for each NHS site. Analysis indicated that neither the GTT nor the two-stage process was a candidate tool for routine surveillance, and a hybrid one-stage tool (Harm2), based on phase 1 findings, was developed for ongoing AE monitoring. Using the Harm2 tool, AEs were identified in 371 out of 3352 randomly selected discharge reviews (11.3%, 95% CI 10.2% to 12.4%), and 59.6% (95% CI 55.3 to 63.9) of these were preventable. In a cohort of randomly selected deceased patient reviews, at least one AE was determined in 315 out of 1018 admissions (30.1%, 95% CI 28.1% to 33.8%), and 61.7% (95% CI 57.5% to 65.9%) of these were preventable. Factors associated with AEs in the randomly selected discharge reviews included having peripheral vascular disease [odds ratio (OR) 2.52], hemiplegia (OR 2.27) or dementia (OR 2.27). No association with chronic disease was identified in the deceased episodes of care.LimitationsThe dependence on our health service partners in identifying notes to be reviewed, along with the small sample examined each month, limits the generalisability of these findings and rates were not standardised for hospital and size and level of services provided. We cannot rule out the possibility that the rates we report may be underestimated.ConclusionThe extent of harm detected across NHS Wales using both the two-stage retrospective review process and the new Harm2 tool conforms to the findings in the literature, but this is the first longitudinal study using these methods. With training and using a structured review process, non-physician reviewers can undertake case note review efficiently and effectively, and the rates of AEs and of the preventability and the breakdown of problems in care conform to those reported in studies in which physicians undertake these classifications. Whether the patient died or was discharged alive significantly influences the rate and composition of AEs. The Harm2 tool performed with moderate reliability in the determination of AEs.Future workFuture large-scale studies should attempt to specify types of AEs, such as hospital-acquired infections and surgical complications, to enable the surveillance of the specific types of harm as well as the overall level of AEs. In the longer term, we need to automate harm surveillance and set measures of harm alongside measures of the beneficial effects of health care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…No estudo de Von Plessen et al [14] identificaram diferenças significativas entre taxas de danos encontrados em 5 hospitais, através da ferramenta GTT e taxa média dos EA foi de 25%, dos quais 96% dos danos foram temporários.…”

Section: Resultsunclassified

Trigger Tool na Segurança do Doente: Uma Revisão Sistemática de Literatura

Pierdevara¹,

Ventura²,

Eiras

et al. 2017

Port J Public Health

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Introdução: A elevada incidência de eventos adversos (EA) é uma das situações preocupantes descritas na literatura sendo relacionada diretamente com o aumento dos custos com a prestação de cuidados de saúde e com o aumento do número de dias de internamento. A metodologia Global Trigger Tool (GTT) é relativamente nova mas tem-se mostrado promissora, em contextos internacionais, em ações de rastreio dos EA. Objetivo: Obter um corpo de evidência, reunindo um conjunto de informações acerca da utilização desta metodologia em contexto hospitalar. Metodologia: Trata-se de uma revisão sistemática da literatura, baseada em estudos primários relacionados com esta temática, publicados entre o ano 2009 e 2014. Resultados: O estudo incluiu 8 estudos primários e os resultados evidenciam dados relevantes acerca da utilidade da ferramenta GTT no âmbito hospitalar. Conclusão: A evidência científica mostra que a aplicação do método GTT, como estratégia de monitorização dos EA, é uma ferramenta viável, uma vez que permite acompanhar a implementação de mudanças orientadas para a redução da ocorrência dos EA.

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Experiences with global trigger tool reviews in five Danish hospitals: an implementation study

Cited by 52 publications

References 21 publications

Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members

Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Trigger Tool na Segurança do Doente: Uma Revisão Sistemática de Literatura

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