Many hospitals continue to use incident reporting systems as their primary patient safety data source. The information incident reporting systems collect on the frequency of harm to patients (adverse events) is generally of poor quality, and some incident types (e.g., diagnostic errors) are under-reported. Other methods of collecting patient safety information using medical record review, such as the Global Trigger Tool, have been developed. The aim of this study was to undertake a systematic review to empirically quantify the gap between the percentage of adverse events detected using the Global Trigger Tool to those that are also detected via incident reporting systems.
The review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies published in English, which collected adverse event data using the Global Trigger Tool and incident reporting systems, were included.
In total, 14 studies met the inclusion criteria. All studies were undertaken in hospitals and were published between 2006 and 2022. The studies were conducted in six countries, mainly the United States (nine studies). Studies reviewed 22,589 medical records using the global trigger tool across 107 institutions finding 7,166 adverse events.The percentage of adverse events detected using the Global Trigger Tool that were also detected in corresponding incident reporting systems ranged from 0 to 37.4% with an average of 7.0% (SD 9.1; median 3.9, IQR 5.2). Twelve of the fourteen studies found less than 10% of the adverse events detected using the global trigger tool were also found in corresponding incident reporting systems.
The greater than ten-fold gap between the detection rates of the Global Trigger Tool and incident reporting systems is strong evidence that the rate of adverse events collected in incident reporting systems in hospitals should not be used to measure or as a proxy for the level of safety of a hospital. Incident reporting systems should be recognised for their strengths which are to detect rare, serious and new incident types, and to enable analysis of contributing and contextual factors to develop preventive and corrective strategies.Health systems should use multiple patient safety data sources to prioritise interventions and promote a cycle of action and improvement based on data rather than merely just collecting and analysing information.