IHI Global Trigger Tool for Measuring Adverse Events

Note: Translations of this paper also available for download.

The IHI Global Trigger Tool for Measuring Adverse Events provides an easy-to-use method for accurately identifying adverse events (harm) and measuring the rate of adverse events over time. Tracking adverse events over time is a useful way to tell if changes being made are improving the safety of the care processes. 

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 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

How to Cite This Paper:
Griffin FA, Resar RK. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2009. (Available at ihi.org)

Related Content

• Introduction to Trigger Tools for Identify Adverse Events
• Training Record Set for IHI Global Trigger Tool
• 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.

Translations and Adaptations of the Tool

Translated versions of the IHI Global Trigger Tool are available in Danish, German, Italian, Portuguese, 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 work in the UK with the Safer Patients Initiative, NHS Institute for Innovation and Improvement, and other related initiatives. 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.

Background

Traditional efforts to detect adverse events 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 quantify the degree and severity of harm, and to select and test changes to reduce harm.

Many hospitals have used this tool to identify adverse events, to measure the level of harm from each adverse event, and to identify areas for improvement in their organizations. It is important to note, however, that the IHI Global Trigger Tool is not meant to identify every single adverse event in a patient record. The recommended time limitation for review and the random selection of records are designed to produce a sampling approach that is sufficient for the design of safety work in the hospital.

In May 2000, the Institute for Healthcare Improvement (IHI) formed the Idealized Design of the Medication System (IDMS) Group — a group of 30 physicians, pharmacists, nurses, statisticians, and other professionals — which established an aim to design a medication system that is safer by a factor of 10 and more cost-effective than systems currently in use. The Trigger Tool for Measuring Adverse Drug Events was initially developed by this group and provided the basis for development of subsequent Trigger Tools.

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.