Developing and implementing a standardized process for global trigger tool application across a large health system.

Area of Science:

• Healthcare Quality Improvement
• Patient Safety Research
• Health Informatics

Background:

• Voluntary adverse event reporting has limitations in detecting the full scope and severity of patient harms.
• The Adventist Health System (AHS) sought a more comprehensive method to identify adverse events.

Purpose of the Study:

• To implement and evaluate the Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) for systematic adverse event detection.
• To establish a centralized process for uniform application of the GTT across multiple hospitals.
• To identify common types and severity of adverse events within a large health system.

Main Methods:

• The Global Trigger Tool (GTT) was implemented in 25 AHS hospitals with a common electronic medical record (EMR) starting in 2009.
• A centralized review process utilizing the common EMR ensured uniform data collection and consistent application of the GTT.
• Quarterly reports and case studies were disseminated to facilities to guide quality improvement efforts.

Main Results:

• A review of 17,295 patient records identified key clusters of adverse events.
• These included medication-related events (glycemic, delirium, bleeding, skin reactions) and pressure ulcers.
• The GTT provided a detailed understanding of the types and frequency of patient harms.

Conclusions:

• The AHS experience demonstrates a successful large-scale implementation of the GTT for harm detection.
• Streamlined reporting and review processes have been developed since 2009.
• Findings from GTT reviews informed systemwide quality improvement projects, particularly for glycemic management and pressure ulcer prevention.