A Paediatric Trigger Tool for measuring adverse events

In 2008 the NHS Institute for Innovation and Improvement sponsored the development of a paediatric trigger tool. Building upon the work of the Institute of Healthcare Improvement in the USA who had developed a Global Trigger Tool, the Institute was keen to produce a bespoke version that could be used in hospitalised children – as none existed in the UK at that time.

As a senior associate at the NHS Institute Nicola Davey (who is now Director of The Quality Improvement Clinic) played a key role in the coproduction and development of this work.

Bringing together patient safety experts, international leaders in Paediatric Trigger Tool development and clinicians from nine hospital across England and Scotland to agree and test 40 paediatric triggers to be included in the tool.

A crucial part of the development was a web-based trigger tool portal which, under Nicola’s management, was created by the NHS Institute and enabled hospitals to enter anonymised data that could then calculate harm rates. This data could then be visualised in run charts and used by hospitals to further their understanding of local harm and improve patient safety. Importantly contributing organisations also gave permission for the data to be used for further research and publication into understanding harm in hospitalised children.

In 2014 Nicola Davey co-authored a paper with Sue Chapman, John Fitzsimons and Peter Lachman which was published by the British Medical Journal and represented the largest study of paediatric harm using the trigger tool methodology in the UK.

Data taken from case note reviews and submitted via the trigger tool by 25 hospitals between 2008 and 2011 showed that most adverse events resulted in temporary harm to the patient (n=923, 92% cases). There were 43 adverse events which required life sustaining intervention and 18 resulting in permanent harm. In 17 cases the adverse event was thought to have contributed to the child’s death.

The study concluded that at present there is a “significant, measurable level of harm which is sometimes severe, experienced by children admitted to hospitals in the UK”. The Paediatric Trigger Tool has provided a new perspective on harm in children caused by healthcare interventions and a set of data that will lead to proactive safety measures rather than a reactive approach. The tool continues to provide information that promotes learning and the improvement of paediatric patient safety.