How to Improve

Learn about the Model for Improvement, forming the improvement team, setting aims, establishing measures, and selecting and testing changes. Go to How to Improve.

Trigger Tools

The use of "triggers," or clues, to identify adverse events (AEs) is an effective method for measuring the overall level of harm from medical care in a health care organization. Traditional efforts to detect AEs have focused on voluntary reporting and tracking of errors. However, public health researchers have established that only 10 to 20 percent of errors are ever reported and, of those, 90 to 95 percent cause no harm to patients. Hospitals need a more effective way to identify events that do cause harm to patients, in order to select and test changes to reduce harm.

Trigger Tools provide an easy-to-use method for accurately identifying AEs (harm) and measuring the rate of AEs over time. Tracking AEs over time is a useful way to tell if changes being made are improving the safety of the care processes.

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Introduction to Trigger Tools for Measuring Adverse Events

IHI Global Trigger Tool for Measuring Adverse Events (Second Edition)
This white paper provides information on the development and methodology of the IHI Global Trigger Tool, enabling the ability to accurately identify adverse events and measure the rate of adverse events over time.
IHI Trigger Tool for Measuring Adverse Drug Events
A method for using "triggers," or clues, in patient records to identify ADEs that may not have been reported through traditional mechanisms).
Training Record Set for IHI Global Trigger Tool
Use this Training Record Set to train new reviewers how to use the IHI Global Trigger Tool for Measuring Adverse Events.

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IHI Global Trigger Tool for Measuring Adverse Events

The use of "triggers," or clues, to identify adverse events (AEs) is an effective method for measuring the overall level of harm in a health care organization.
IHI Global Trigger Tool Training Resources

A suggested plan and resources to help train reviewers on the IHI Global Trigger Tool methodology.
IHI Intensive Care Unit (ICU) Adverse Event Trigger Tool

The ICU Adverse Event Trigger Tool provides instructions for conducting a retrospective review of patient records using triggers to identify possible adverse events.
IHI Outpatient Adverse Event Trigger Tool

This tool is used to identify outpatient-related adverse events using specifically defined "triggers" (or clues).
IHI Perinatal Trigger Tool

The Perinatal Trigger Tool provides instructions for conducting a retrospective review of patient records using triggers to identify possible adverse events causing any physical harm to the infant or mother.

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WIHI: The Power to Detect and Improve: Revisiting the IHI Global Trigger Tool and Adverse Events

April 14, 2011 | The authors discuss a new study in Health Affairs that finds that the IHI Global Trigger Tool identified at least ten times more confirmed, serious events than other methods.
WIHI: The Power to Detect and Reduce Harm: IHI’s Global Trigger Tool and Adverse Events in the US

October 21, 2010 | This WIHI provides a window into research findings from a series of reports from the Office of Inspector General and their significance for patient safety, harm detection, improvement work, and policy reform going forward. The IHI Global Trigger Tool for identifying adverse events is also a focus of the discussion.

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Passport Exclusive: Improvement Skills to Empower Front-Line Nurses II

This recording discusses Managing Patient Care Risk: Beyond the Checklist. How does the front-line nurse engage her team, foster communication, and improve teamwork — the three requirements for effective use of a checklist?
Passport Exclusive: Improvement Skills to Empower Front Line Nurses I

This recording discusses Developing a Sensitivity to Risk, including many tools that can help uncover and reduce risk and patient harm.

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10 IHI Innovations to Improve Health and Health Care

This curated publication highlights 10 ideas that have emerged from IHI's systematic 90-day innovation approach, including reflections on the Triple Aim, the concept of a health care Campaign, the Breakthrough Series Collaborative model, and other frameworks and fresh thinking that have been replicated around the world.
Development of a Trigger Tool to Identify Adverse Events and Harm in Emergency Medical Services

This article describes the development and implementation of the Emergency Medical Services Trigger Tool (EMSTT), a sampling strategy similar to the Global Trigger Tool with EMS-specific triggers, to identify and measure adverse events and harm over time in the Emergency Medical Services setting.
Performance of the Global Assessment of Pediatric Patient Safety (GAPPS) Tool

This study's objective was to develop and test the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, which measures hospital-wide rates of adverse events (AEs) and preventable AEs. The study found that the GAPPS tool reliably identifies AEs among pediatric inpatients and can be used to guide and monitor quality and safety improvement efforts.
IHI Skilled Nursing Facility Trigger Tool for Measuring Adverse Events

The IHI Skilled Nursing Facility Trigger Tool for Measuring Adverse Events provides an easy-to-use method for accurately identifying adverse events (harm) and measuring the rate of adverse event incidence over time in skilled nursing facilities (SNFs).
Signal and Noise: Applying a Laboratory Trigger Tool to Identify Adverse Drug Events among Primary Care Patients

This study tests the use of six abnormal laboratory triggers for detecting adverse drug events among adults in outpatient care.

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Certified Professional in Patient Safety (CPPS) Review Course
August 2 – 3, 2023

The Certified Professional in Patient Safety credential (CPPS) establishes core standards for the field and sets an expected proficiency level for those seeking to become professionally certified in patient safety.
Patient Safety Executive Development Program
Fall 2023 | Boston, MA

With today’s shrinking health care budgets and growing focus on costs, it has never been more important to have a robust safety plan. Maintaining a powerful safety program is essential to the long-term health of your department, organization, or health care system — and to ensuring that your patients receive the safe and reliable care they deserve. To position your organization for success, attend IHI’s Patient Safety Executive Development Program.
IHI Forum 2023
December 10–13, 2023 | Orlando, FL, USA

The IHI Forum is a four-day conference that has been the home of quality improvement (QI) in health care for more than 30 years. Attend this year's conference in Orlando, FL, USA.