‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured

Adverse Events in Hospitals May Be Ten Times More Common Than Previously Measured, According to the “Global Trigger Tool”

  1. 1.  David C. Classen1,*,
  2. 2.  Roger Resar2,
  3. 3.  Frances Griffin3,
  4. 4.  Frank Federico4,
  5. 5.  Terri Frankel5,
  6. 6.  Nancy Kimmel6,
  7. 7.  John C. Whittington7,
  8. 8.  Allan Frankel8,
  9. 9.  Andrew Seger9 and

10.Brent C. James10

+Affiliated Authors

1.One David C. Classen is an associate professor of medicine at the University of Utah in Salt Lake City (
2.Roger Resar is a senior fellow of the Cambridge, Massachusetts-based Institute for Healthcare Improvement.
3.Professor Frances Griffin works with the Institute for Healthcare Improvement.
4.Frank Federico is the institute for healthcare improvement’s executive director.
5.Director at the Institute for Healthcare Improvement is Terri Frankel.
6.At the Missouri Baptist Medical Center in St. Louis, Nancy Kimmel serves as the department head for quality and safety.
7.John C. Whittington works with the Institute for Healthcare Improvement as a senior fellow.
8.At Boston, Massachusetts’ Brigham and Women’s Hospital, Allan Frankel teaches as an associate professor.
9.Andrew Seger is a Brigham and Women’s Hospital assistant professor.
10.Brendon C. James works as Intermountain Healthcare’s chief quality officer in Salt Lake City, Utah.

  1. *Corresponding author


Patient safety is centered on the identification and monitoring of adverse medical events, which lays the groundwork for accountability, helps prioritize issues to address, sparks ideas for safer care, and tests which actions are effective. We used the same patient sample set from three top hospitals to assess three approaches for identifying adverse events in hospitalized patients. We discovered that the two approaches most frequently used in the United States today to monitor patient safety—voluntary reporting and the Patient Safety Indicators developed by the Agency for Healthcare Research and Quality—performed very badly and missed 90% of the adverse events. The Global Trigger Tool developed by the Institute for Healthcare Improvement discovered at least ten times as many confirmed, significant occurrences. Unfavorable incidents happened in one-third of hospital admissions overall. The Patient Safety Indicators and voluntary reporting could lead to inaccurate conclusions about the existing level of care safety in the US healthcare system and misdirect efforts to increase patient safety.