Assessment of adverse events in medical care: lack of consistency between experienced teams using the global trigger tool

Schildmeijer, Kristina; Nilsson, Lena; Årestedt, Kristofer; Perk, Joep

doi:10.1136/bmjqs-2011-000279

Cited by 75 publications

(100 citation statements)

References 26 publications

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“…In other studies reviewed (Naessens et al 2010;Schildmeijer et al 2012) inter-rater reliability was variable, depending on the object of review (the presence of an AE, severity, preventability) and the type of reviewers compared (nurses vs. physicians, internal vs. external reviewer teams, etc.). Generally, in most studies, there seems to be at least a moderate level of agreement achieved (higher when internal reviewers are used, as in the study of Sharek et al (2011).…”

Section: Inter-rater Reliabilitymentioning

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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Section: Inter-rater Reliabilitymentioning

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 Institute for Healthcare Improvement's Global Trigger Tool (IHI GTT) is widely used as a method to measure and monitor AEs in general hospitalised patients [3,6]. Despite this method's high sensitivity and specificity in detecting iatrogenic harm, there are limitations [7][8][9]. One Danish study raises methodological concerns of the IHI GTT, not being specific enough in monitoring harm in cancer patients [10].…”

Section: Introductionmentioning

confidence: 99%

Adverse events in hospitalised cancer patients: a comparison to a general hospital population

et al. 2017

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Background: Patients with cancer are often treated by many healthcare providers, receive complex and potentially toxic treatments that can increase the risk for iatrogenic harm. The aim of this study is to investigate whether hospitalised cancer patients are at higher risk of adverse events (AEs) compared to a general hospital population. Material and methods: A total of 6720 patient records were retrospectively reviewed comparing AEs in hospitalised cancer patients to a general hospital population in Norway, using the IHI Global Trigger Tool method. Results: 24.2 percent of admissions for cancer patients had an AE compared to 17.4% of admissions of other patients (p < .001, rr 1.39, 95% CI 1.19-1.62). However, cancer patients did not have a higher rate of AEs per 1000 patient days compared to other patients, 37.1 vs. 36.0 (p ¼ .65, rr 0.94, 95% CI 0.90-1.18). No particular cancer category is at higher risk. The rate of AEs increases by 1.05 times for each day spent in hospital. For every year increase in age, the risk for AEs increases by 1.3%. Cancer patients more often have hospital-acquired infections, other surgical complications and AEs related to medications. Conclusions: Because of higher age, longer length of stay and surgical treatment, hospitalised cancer patients experience AEs more often than other patients.

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“…18 Recent reports have emphasized the subjective nature of the IHI trigger tool and its variability when implemented as well as evidence that it may identify fewer events than some historically used tools. [32][33][34] As mentioned previously, it is reasonable to conclude that the IHI global trigger tool is useful for efficiently identifying many adverse events, but it may not be able to reliably generate data for temporal trends or comparisons between institutions.…”

Section: Approaches To Quality Evaluationmentioning

confidence: 94%

Adverse Event Reporting and Quality Improvement in the Intensive Care Unit

Heavner

Siner

2015

Clinics in Chest Medicine

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Assessment of adverse events in medical care: lack of consistency between experienced teams using the global trigger tool

Abstract: The results do not encourage the use of the GTT for making comparisons between hospitals. The use of the GTT to this end would require substantial training to achieve better agreement across reviewer teams.

Cited by 75 publications

References 26 publications

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

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

Adverse events in hospitalised cancer patients: a comparison to a general hospital population

Adverse Event Reporting and Quality Improvement in the Intensive Care Unit

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