Data from: Experiences with Global Trigger Tool reviews in five Danish hospitals – an implementation study

Objectives: To describe experiences with the implementation of global trigger tool (GTT) reviews in five Danish hospitals and to suggest ways to improve the performance of GTT review teams. Design: Retrospective observational study. Setting: The measurement and monitoring of harms are crucial to campaigns to improve the safety of patients. Increasingly, teams use the GTT to review patient records and measure harms in English and non-English-speaking countries. Meanwhile, it is not clear as to how the method performs in such diverse settings. Participants: Review teams from five Danish pilot hospitals of the national Danish Safer Hospital Programme. Primary and secondary outcome measures: We collected harm rates, background and anecdotal information and reported patient safety incidents (PSIs) from five pilot hospitals currently participating in the Danish Safer Hospital Programme. Experienced reviewers categorised harms by type. We plotted harm rates as run-charts and applied rules for the detection of patterns of non-random variation. Results: The hospitals differed in size but had similar patient populations and activity. PSIs varied between 3 and 12 per 1000 patient-days. The average harm rate for all hospitals was 60 per 1000 patient-days ranging from 34 to 84. The percentage of harmed patients was 25 and ranged from 18 to 33. Overall, 96% of harms were temporary. Infections, pressure ulcers procedure-related and gastrointestinal problems were common. Teams reported differences in training and review procedures such as the role of the secondary reviewer. Conclusions: We found substantial variation in harm rates. Differences in training, review procedures and documentation in patient records probably contributed to these variations. Training reviewers as teams, specifying the roles of the different reviewers, training records and a database for findings of reviews may improve the application of the GTT.

研究目标：阐述全球触发工具（Global Trigger Tool，GTT）审查在五家丹麦医院的实施经验，并提出优化GTT审查团队绩效的可行路径。
研究设计：回顾性观察研究。
研究背景：医疗伤害的测量与监测是提升患者安全行动的核心环节。当前，英语及非英语国家的医疗团队愈发普遍采用GTT审查患者病历、量化医疗伤害，但该方法在多元医疗场景中的应用效果尚未明确。
研究对象：参与丹麦全国安全医院项目的五家试点医院的审查团队。
主要与次要结局指标：收集当前参与丹麦安全医院项目的五家试点医院的伤害发生率、背景资料与轶事信息，以及上报的患者安全事件（Patient Safety Incident，PSI）。由资深审查人员按类型对医疗伤害进行分类。将伤害发生率绘制成运行图，并应用规则检测非随机变异模式。
研究结果：各医院规模存在差异，但患者群体与诊疗活动量相近。PSI发生率介于每1000住院日3至12例区间。所有医院的平均伤害发生率为每1000住院日60例，区间为34至84例。受伤害患者占比为25%，区间为18%至33%。整体而言，96%的医疗伤害为暂时性伤害。感染、压疮、操作相关伤害及胃肠道问题为常见伤害类型。审查团队反馈，在培训及审查流程（如二级审查员的职责界定）方面存在差异。
结论：本研究发现医疗伤害发生率存在显著差异。培训、审查流程及患者病历文档的差异或为该变异的潜在诱因。以团队形式开展审查人员培训、明确不同审查人员的职责、规范培训记录，以及建立审查结果数据库，或可改善GTT的应用效果。