IHI_Global_Trigger_Tool v.1

The IHI Global Trigger Tool (GTT) is used to measure the prevalence of possible Adverse Events in in-patient's records. It uses "triggers" (or clues), that have been identified to occur commonly in cases where the patient has suffered harm or injury related to medical care. The tool must only be used if the record complies to the following pre-conditions: (1) patient >= 18 years old, (2) patient's length of stay > 24 hours, (3) patient record must be closed and codified, and (4) patient was NOT inpatient psychiatric or rehabilitation patient.

Rosario Silva Sepulveda


@ CambioCDS

The IHI Global Trigger Tool (GTT) for Measuring Adverse Events (AE) provides a method to identify possible adverse events (harm or injury) that may have occurred during the patient's hospital stay.

Retrospective review of inpatient hospital records to identify clues or triggers of AE. Contains six modules: Care, Medication, Surgery, Intensive Care, Perinatal, and Emergency Department. Only the Care and Medication Modules need to be filled for all records, the rest should be omitted if it does not apply to the patient stay. Identify AE, assess the level of harm of each, and correlate the occurrence to the impact of improvement efforts. Improve decision-making regarding quality and safety improvement within healthcare settings. After the triggers are identified in a patient's record, further analysis must be conducted by the reviewer to determine if the trigger relates to any of the following types of harm: Category E: Temporary harm to the patient and required intervention Category F: Temporary harm to the patient and required initial or prolonged hospitalization Category G: Permanent patient harm Category H: Intervention required to sustain life Category I: Patient death

Not to use in records of patients who are less than 18 years old. Not to use in records of inpatient psychiatric or rehabilitation patients. Not to use in records of patients with less than 24 hours stay. Not to use in records of patients that have not been closed and codified. Not to use as a punitive tool against healthcare professionals. The GTT must be part of the implementation tools to enhance and promote Patient Safety Culture, focused on continuous improvement rather than culpability or punishment.

1. Griffin FA, Resar RK. IHI Global Trigger Tool for Measuring Adverse Events [Internet]. HI - Institute for Healthcare Improvement; 2009 [cited 2021 Jan 28]. Available from: http://www.ihi.org:80/resources/Pages/Tools/IHIGlobalTriggerToolforMeasuringAEs.aspx 2. Classen D, Resar R, Griffin F, Federico F, Frankel T, Kimmel N, et al. “Global Trigger Tool” Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured. Health affairs (Project Hope). 2011 Apr 1;30:581–9. doi: 10.1377/hlthaff.2011.0190 3. Doupi P, Svaar H, Bjørn B, Deilkås E, Nylén U, Rutberg H. Use of the Global Trigger Tool in patient safety improvement efforts: Nordic experiences. Cogn Tech Work. 2015 Feb 1;17(1):45–54. doi: 10.1007/s10111-014-0302-2 4. Musy SN, Ausserhofer D, Schwendimann R, Rothen HU, Jeitziner M-M, Rutjes AW, et al. Trigger Tool-Based Automated Adverse Event Detection in Electronic Health Records: Systematic Review. J Med Internet Res. 2018 May 30;20(5):e198. doi: 10.2196/jmir.9901