Utility of a Paediatric Trigger Tool in a Norwegian department of paediatric and adolescent medicine

OBJECTIVES The British National Health Service (NHS) Paediatric Trigger Tool (PTT) was made based on various trigger tools developed for use in adults. The PTT has not previously been developed or used in Nordic units. We aimed to compare harm identified through PTT screening with voluntary incidence reports in our department. A secondary aim was to assess utility of the different triggers, including predictive value for identifying harm. We hypothesised that the NHS PTT would need adjustments for the setting in which it is used. SETTING A Norwegian level II department of paediatric and adolescent medicine. PARTICIPANTS A convenience sample of 761 acute medical and surgical patient contacts March-May 2011. Median age (IQR) for the trigger positive patients was 2.5 (1.0-8.0) years; range 0-18 years. PRIMARY AND SECONDARY OUTCOME MEASURES Incidence, type and severity of harm identified with the PTT compared with the department's voluntary incidence reports. The type and rate of identified triggers and positive predictive value for harm. RESULTS The PTT revealed a harm rate of 5% for medical patients, as compared to 0.5% in the incidence reports the same months. PTT screening revealed other types of harm than those reported by healthcare personnel themselves. We identified only 20 of the 39 NHS PTT triggers. The most frequent trigger was readmission within 30 days. Hypoxia, which was the second most frequent trigger, did not predict any patient harm. CONCLUSIONS This study showed that the NHS PTT identifies more and other types of harm than voluntary incidence reports. The presence of adult-oriented triggers, triggers that were not identified at all, as well as triggers with a low predictive value for harm may indicate the need for modification of the PTT to different settings. More studies are needed before a final decision is made to exclude triggers from the screening.