At the end of 2006, the Institute of Healthcare Improvement (IHI) leadership announced the 5 Million Lives campaign to foster prevention of adverse events. The IHI global trigger tool (GTT) is the primary measurement tool used to determine degree of campaign success. There is a dearth of data regarding the actual utility of this tool. Lacking this peer‐reviewed information, the IHI 5 Million Lives campaign led us to critically review the GTT and our experience.


Standardized sessions utilizing identical training charts for the IHI GTT were used in all 3 locations. Two non‐physicians reviewed each patient record for presence of triggers and adverse events and conferred findings. A physician validated their consensus results. Adverse events were categorized by severity and type of event and collected in a central database. The GTT was used to establish a baseline rate of institutional adverse events and to follow the adverse event rate over time for detection of change.


From January 2005 through December 2006, 1297 charts were reviewed. In the first year (2005) the 3 hospitals averaged 81 adverse events/1000 patient‐days. In the following year (2006) the hospitals averaged 61 adverse events/1000 patient‐days. The improvement between these 2 time frames was 28.39%, even though improvement work was ongoing during all the months and not limited to 2006. The percent of hospitalizations with an adverse event decreased from 28.3% to 23.7%. Most adverse events were associated with temporary harm and did not require and lengthen hospitalization.


The IHI global trigger tool can be used to detect adverse events and monitor trends in adverse event rates over time.

Author Disclosure:

J. Huddleston, MD, none; J. Naessens, none; C. McGlone, none; R. Resar, none; S. Swensen, none.