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Assessment of the global trigger tool to measure, monitor and evaluate patient safety in cancer patients: reliability concerns are raised
  1. Thea Otto Mattsson1,2,
  2. Janne Lehmann Knudsen3,
  3. Jens Lauritsen2,4,
  4. Kim Brixen2,5,
  5. Jørn Herrstedt1,2
  1. 1Department of Oncology, Odense University Hospital, Odense, Denmark
  2. 2Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  3. 3Danish Cancer Society, Copenhagen, Denmark
  4. 4Accident Analysis Group, Department of Orthopaedics, Odense University Hospital, Odense, Denmark
  5. 5Department of Endocrinology, Odense University Hospital, Odense, Denmark
  1. Correspondence to Thea Otto Mattsson, Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, Odense C 5000, Denmark; thea.otto.mattsson{at}


Background Countries around the world are currently aiming to improve patient safety by means of the Institute for Healthcare Improvement global trigger tool (GTT), which is considered a valid tool for evaluating and measuring patient safety within organisations. So far, only few data on the measurement properties and utility of the GTT have been published.

Aims To determine and evaluate the effect of interrater variation between review teams on the standard outcome measures of the GTT and to assess and quantify measurement error of the GTT.

Methods Retrospective chart reviews were conducted on identical charts by two independent review teams in 2010 at a department of oncology in a university hospital. Standard GTT outcome measurements were obtained and compared between teams using statistical process control (SPC) charts. A Bland–Altman plot assessed measurement error and limits of agreement.

Results Only 31% of adverse events (AE) were identified by both teams, and further differences in categorisation of identical events was found. Moderate interrater agreement (κ=0.45) between teams gave rise to different conclusions on the patient safety process when monitoring using SPC charts. The Bland–Altman plot suggests little systematic error but large random error.

Conclusions Review teams may identify different AE and reach different conclusions on the safety process when using the GTT on identical charts. Tracking true change in the safety level is difficult due to measurement error of the GTT. The results do not encourage further use of the GTT until additional evaluation studies on the measurement properties of the GTT have been conducted.

  • Trigger tools
  • Patient safety
  • Performance measures
  • Adverse events, epidemiology and detection
  • Statistical process control

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