Institute for Healthcare Improvement
Cambridge, Massachusetts, USA
The use of "triggers," or clues, to identify adverse events (AEs) is an effective method for measuring the overall level of harm in a health care organization. The IHI Global Trigger Tool for Measuring AEs provides instructions for training reviewers in this methodology and conducting a retrospective review of patient records using triggers to identify possible AEs. This tool includes a list of known AE triggers as well as instructions for selecting records, training information, and appendices with references and common questions. The tool provides instructions and forms for collecting the data you need to track three measures:
- Adverse Events per 1,000 Patient Days
- Adverse Events per 100 Admissions
- Percent of Admissions with an Adverse Event
Traditional efforts to detect AEs have focused on voluntary reporting and tracking of errors. 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. In 2000, a group of IHI faculty consisting of clinical experts and other professionals developed the first IHI Trigger Tool in an effort to detect a greater number of AEs. Over time, multiple topic and location specific Trigger Tools have been developed and the IHI Global Trigger Tool combines several of these into one tool that can be used to measure harm at the hospital level.
Since its development in late 2003, use of the IHI Global Trigger Tool has spread from collaborative projects to large-scale improvement efforts, including IHI’s 5 Million Lives Campaign. The IHI Global Trigger Tool has become a tool that hundreds of hospitals in multiple countries now use to monitor adverse event rates while working to improve patient safety. In 2008, the US Department of Health and Human Services Office of Inspector General completed a pilot study to measure adverse events in Medicare beneficiaries and used the IHI Global Trigger Tool as one method of detection. This extensive use of the IHI Global Trigger Tool has provided the opportunity to collect feedback from those using the tool and identify opportunities to clarify definitions and update material.
Translations and Adaptations of the Tool
Translated versions of the IHI Global Trigger Tool are available in Danish, German, and Swedish.
The UK version of the tool has been adapted to reflect the local UK context. This version was last revised in September 2008 as part of IHI's continuing work in the UK with the Safer Patients Initiative, NHS Institute for Innovation and Improvement, and other related initatives. The revisions are as follows:
- The following triggers have been added back into the tool:
- G7 – Complication of procedure or treatment
- G8 – Transfer to higher level of care
- M5 – Abrupt medication stop
- The supporting explanation for G7 and G8 from the 2005 UK version of the IHI Global Trigger Tool has been retained.
- A paragraph has been provided for M5 as the 2005 text was not precisely what is being taught in the UK.
Related Literature and Information
Classen DC, Lloyd RC, Provost L, Griffin FA, Resar R. Development and evaluation of the Institute for Healthcare Improvement Global Trigger Tool. Journal of Patient Safety. 2008 Sep;4(3):169-177.
Adler L, Denham CR, McKeever M, Purunton R, Guilloteau F, Moorhead D, Resar R. Global Trigger Tool: Implementation basics. Journal of Patient Safety. 2008 Dec;4(4):245-249.
See related resources:
The IHI Global Trigger Tool for Measuring AEs contains:
- Background on Development and Methodology
- Rules and Methods for Use
- Triggers and Definitions
- Training Instructions
- Stories from Experienced Organizations
- References and Resources