Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities

Good, Vicki S.; Saldaña, Margaret; Gilder, Richard E.; Nicewander, David; Kennerly, Donald A.

doi:10.1136/bmjqs.2008.029181

Cited by 57 publications

(68 citation statements)

References 16 publications

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“…However, recent studies from the USA include preventability assessments to enhance learning opportunities and guide quality improvement 9 10. Landrigan et al 11 reported that internal reviewers rated 63.1% of the AEs found as preventable.…”

Section: Discussionmentioning

confidence: 99%

Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method

et al. 2014

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ObjectivesTo describe the level, preventability and categories of adverse events (AEs) identified by medical record review using the Global Trigger Tool (GTT). To estimate when the AE occurred in the course of the hospital stay and to compare voluntary AE reporting with medical record reviewing.DesignTwo-stage retrospective record review.Setting650-bed university hospital.Participants20 randomly selected medical records were reviewed every month from 2009 to 2012.Primary and secondary outcome measuresAE/1000 patient-days. Proportion of AEs found by GTT found also in the voluntary reporting system. AE categorisation. Description of when during hospital stay AEs occur.ResultsA total of 271 AEs were detected in the 960 medical records reviewed, corresponding to 33.2 AEs/1000 patient-days or 20.5% of the patients. Of the AEs, 6.3% were reported in the voluntary AE reporting system. Hospital-acquired infections were the most common AE category. The AEs occurred and were detected during the hospital stay in 65.5% of cases; the rest occurred or were detected within 30 days before or after the hospital stay. The AE usually occurred early during the hospital stay, and the hospital stay was 5 days longer on average for patients with an AE.ConclusionsRecord reviewing identified AEs to a much larger extent than voluntary AE reporting. Healthcare organisations should consider using a portfolio of tools to gain a comprehensive picture of AEs. Substantial costs could be saved if AEs were prevented.

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Section: Discussionmentioning

confidence: 99%

Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method

et al. 2014

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“…Many of the groups reporting their experience with the paper-based GTT also refer to the need of a tool integrated with electronic patient record systems (Good et al 2011). Indicatively, in a recent interview, Dr. Classen communicated that IHI has already proof-tested the automation of the GTT in all 'leading EMR vendors at various health systems'' (AHRQ 2012).…”

Section: Discussionmentioning

confidence: 99%

Use of the Global Trigger Tool in patient safety improvement efforts: Nordic experiences

Doupi

Svaar²,

Bjørn³

et al. 2014

Cogn Tech Work

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The Global Trigger Tool (GTT) developed by the Institute for Healthcare Improvement is a method for retrospective patient record review based on the use of 'triggers'-signals of potential adverse events that have caused patient harm. The method has the purpose of patient safety measurement and monitoring among adult inpatient populations and has been increasingly popular among Nordic countries. Use of the GTT in the Nordic area has been part of broader legal and policy actions and initiatives supportive of patient safety promotion and is being used to establish also national level estimates of patient safety incidents. Limitations of the method are its dependency on quality of documentation and the varying inter-rater reliability observed in many studies. Strengths of the GTT are its ability to detect larger numbers, as well as different types of adverse events when compared to other incident detection methods, hence it is a good addition to the palette of means for organizational patient safety monitoring. Research on reliability, usefulness and implementation approaches of the GTT, including its automation, is ongoing in the Nordic countries and is expected to generate useful input for the international patient safety community.

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“…AEs causing patient harm can be identified through retrospective patient record reviews 3 5. The Global Trigger Tool (GTT), developed by the Institute for Healthcare Improvement (IHI),6 is one such method, primarily intended for following the level of AEs on a hospital level, that has been increasingly used 7 8. It identifies AEs causing patient harm caused by medical treatment, not the underlying medical condition of the patient.…”

Section: Introductionmentioning

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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Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities

Cited by 57 publications

References 16 publications

Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method

Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method

Use of the Global Trigger Tool in patient safety improvement efforts: Nordic experiences

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

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