New trigger tool for patient safety calculations in primary care lacks validity

The NHS Institute for Innovation and Improvement has launched a new trigger tool for calculating patient safety adverse event rates in primary care.

The tool is the result of “the world’s largest ever exercise to measure patient safety in primary care” and is said by the Institute “to bring highly sensitive adverse event measurement within reach of every primary care team.”

Yet, despite these claims, the Institute also says that the tool is “not fit for benchmarking purposes” citing the following two problems:

1. The counting of adverse events in patients’ notes relies upon a series of clinical judgements by an individual reviewer.  While any single reviewer is likely to make decisions which are internally consistent with their previous decisions, evidence has shown that consistency between reviewers is poor except in highly controlled settings.  Thus, Trigger Tool series of results produced over time by a single reviewer in a healthcare provider can be regarded as reliable, comparisons between reviewers cannot. 

2.    The adverse event rate in any given healthcare provider will be influenced by a number of factors outside the control of that provider, such as patients’ health and social status, local provision of other health and social care services, and the links between providers.  Valid conclusions therefore cannot be made regarding comparison of adverse event rates in different providers.

Healthcare Governance Review wonders what the real benefits are of using a tool that appears to be lacking in validity. Reader responses are welcome on this subject.

Further information on the tool, including training materials can be found here.

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