Test-Retest Reliability of an Experienced Global Trigger Tool Review Team.

Area of Science:

• Healthcare quality improvement
• Patient safety measurement
• Medical error analysis

Background:

• A patient safety program in Denmark observed a doubling in harm rates measured by the Institute for Healthcare Improvement Global Trigger Tool (GTT).
• Other patient safety indicators remained stable or improved, suggesting the GTT increase might not reflect true harm.
• The review team was experienced and stable, leading to a hypothesis about improved harm identification.

Purpose of the Study:

• To investigate whether the observed increase in patient harm rates was a true rise in harm or a result of enhanced detection by the review team.
• To assess the reproducibility of harm rates using the Global Trigger Tool (GTT) over time.

Main Methods:

• The study re-examined harm rates from two distinct periods (2010 and 2011-2012) at a regional hospital.
• Two samples were analyzed for each period: the original monitoring sample and a new sample drawn for the study.
• The ability of the experienced GTT review team to reproduce previously identified harm rates was assessed.

Main Results:

• Harm rates increased significantly between the two review periods and between the two study samples.
• The increase in harm was exclusively in the 'minor temporary harm' category (Category E).
• The experienced GTT team could not consistently reproduce the harm rates identified in earlier reviews.

Conclusions:

• The Global Trigger Tool (GTT) may not be a reliable measure of patient harm rates over time.
• The increase in measured harm rates is likely attributable to the review team's improved ability to identify minor harms, rather than an actual increase in patient harm.
• Further refinement of the GTT methodology is needed to ensure accurate and consistent patient safety measurement.