Trigger tools healthcare

The GTT is practical for routine improvement efforts and not just research studies, and it includes detailed instructions for training reviewers and interpreting results. Conceptually, though, the method resembles that of major adverse event studies such as the Harvard Medical Practice Study.

Use of the trigger tool involves screening a defined sample of medical records by two independent clinicians for presence of one or more triggers. After a trigger is identified, the entire chart is reviewed to determine whether an adverse event took place, and if so, to grade the level of harm experienced by the patient.

Various studies have assessed the reliability of judgments using the GTT and also modified it for application in different clinical settings, including pediatric patients and patients with cancer. Versions of the tool appropriate for prospective detection in real-time have also been developed. The IHI cautions that the GTT or any trigger tool method cannot identify all sources of patient harm or the cause of harm, a point emphasized in an influential commentary.

Also, trigger tools are designed to detect all adverse events; reviewers are explicitly instructed to avoid making judgments about preventability of these events during the initial review process. Nonetheless, many studies have used the GTT or other similar tools to estimate the frequency of preventable adverse events in a variety of clinical settings.

This is not inappropriate per se, but readers of such studies should be aware that inter-rater agreement around preventability is generally only moderate, as discussed in more detail in the Measurement of Patient Safety primer.

Concerns have also been raised regarding the reliability of trigger tools, both for detection of adverse events and for rating the severity of harm experienced by patients. One Swedish study used 5 teams of reviewers each of whom had at least 3 years of GTT experience to review a random sample of hospitalizations and found that agreement between teams on the presence of an adverse event was only slightly better than chance.

Another influential study of temporal trends in adverse events also found markedly different rates when the GTT was used by personnel internal or external to the hospitals being studied. It is likely that reliability of trigger tools is significantly influenced by the level of training and experience of the reviewers and their familiarity with the clinical setting being evaluated.

Finally, most existing trigger tools have been used to identify adverse events in the inpatient setting. Although some studies have sought to develop trigger tools for ambulatory care , there is relatively little data on the accuracy and reliability of these tools.

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Note that even if you have an account, you can still choose to submit a case as a guest. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. Learn more information here. Provide Feedback Submit a Case. Use quotes to search for an exact match of a phrase. Example: "communication between providers and nurses". Put a minus sign just before words you don't want. Page Content. Trigger Tools provide an easy-to-use method for accurately identifying AEs harm and measuring the rate of AEs over time.

Tracking AEs over time is a useful way to tell if changes being made are improving the safety of the care processes. Start here:. Recommended Resources. A method for using "triggers," or clues, in patient records to identify ADEs that may not have been reported through traditional mechanisms.

Loading Pages The purpose is not only to count harms but more importantly to identify themes so that steps can be taken to minimise the risk of harm and to improve the patient experience of care.

Trigger tools have been shown to identify up to ten times more harm than traditional approaches such as voluntary reporting. However, public health researchers have established that only 10 to 20 percent of errors are ever reported and, of those, 90 to 95 percent cause no harm to patients. Hospitals need a more effective way to identify events that do cause harm to patients, in order to select and test changes to reduce harm.

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