1. Trigger Tool for Community Hospitals Development Programme Development Roadmap The benefits The commitment Dr Robert Varnam Safer Care Team robert.varnam@institute.nhs.uk

2. Key concepts 1. Detecting iatrogenic harm events not error / risk / educational tool 2. Quick & dirty method for casenote review filtered & targetted Therefore triggers must be: easily found in the notes of most patients unambiguous (no judgement call) capture as full a range of harms as possible (reduce false negatives) proven to be associated with iatrogenic harm (reduce false positives)

3. Development Roadmap Ideas about harm Ideas about harm Long List of triggers Long List of triggers Alpha Version(s) Alpha Version(s) Beta Version Beta Version Public Version(s) Public Version(s) No. of people No. of triggers Understand safety Maximise sensitivity Optimise practicability Maximise specificity Spread

4. Common challenges Casenotes – absent / hard to track – messy / incomplete – unlikely to contain both care & harm Harm – mostly arising from omission – difficult to define precisely eg psychological/social, difficult to separate from illness itself – lag time Priorities – Trigger tools aren’t always what people want (first) – focus on common rather than serious harms – not a risk / near miss tool

5. Benefits for you training – passion for patient safety – evidence-based understanding of error – think differently about reporting & detecting safety issues – casenote review measurement of safety better targetting of improvement activity serve the NHS

6. Commitment required staff – experienced diagnostic clinician(s) time – training... ½ day – casenote reviews... 10-20min per patient eg 10 patients per month ≈ 1½-3½ hours per month eg 20 patients per month ≈ 3½-6 hours per month

7. Our commitment project management training (free) data collection & analysis publication & training for the NHS

8. What next? 1.Review priorities 2.Identify resources 3.Contact robert.varnam@institute.nhs.uk