The application of the Global Trigger Tool: a systematic review.
OBJECTIVE
This study describes the use of, and modifications and additions made to, the Global Trigger Tool (GTT) since its first release in 2003, and summarizes its findings with respect to counting and characterizing adverse events (AEs).


METHODS
Peer-reviewed literature up to 31st December 2014.


METHODS
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.


METHODS
Two authors extracted and compiled the demographics, methodologies and results of the selected studies.


RESULTS
Of the 48 studies meeting the eligibility criteria, 44 collected data from inpatient medical records and four from general practice records. Studies were undertaken in 16 countries. Over half did not follow the standard GTT protocol regarding the number of reviewers used. 'Acts of omission' were included in one quarter of studies. Incident reporting detected between 2% and 8% of AEs that were detected with the GTT. Rates of AEs varied in general inpatient studies between 7% and 40%. Infections, problems with surgical procedures and medication were the most common incident types.


CONCLUSIONS
The GTT is a flexible tool used in a range of settings with varied applications. Substantial differences in AE rates were evident across studies, most likely associated with methodological differences and disparate reviewer interpretations. AE rates should not be compared between institutions or studies. Recommendations include adding 'omission' AEs, using preventability scores for priority setting, and re-framing the GTT's purpose to understand and characterize AEs rather than just counting them.
Australian Institute of Health Innovation,  Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.|Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia.
Peter D
PD
Hibbert
Australian Institute of Health Innovation,  Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.|Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia.
Charlotte J
CJ
Molloy
Australian Institute of Health Innovation,  Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.|Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia.
Tamara D
TD
Hooper
Australian Institute of Health Innovation,  Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.|Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia.
Louise K
LK
Wiles
Australian Institute of Health Innovation,  Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.|Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia.|Australian Patient Safety Foundation, PO Box 2471, IPC CWE-53, Adelaide, South Australia 5001, Australia.
William B
WB
Runciman
Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK.
Peter
P
Lachman
James M. Anderson Center for HealthCare Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Stephen E
SE
Muething
Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.
Jeffrey
J
Braithwaite
D016907:Adverse Drug Reaction Reporting Systems / Q000458:organization & administration*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D058006:General Practice / Q000592:standards; D006801:Humans; D007297:Inpatients; D019300:Medical Errors / Q000517:prevention & control*; D061214:Patient Safety / Q000592:standards*
Global Trigger Tool; adverse events; patient safety; quality of care; systematic review