Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members

OBJECTIVES: The aim was to describe the strengths and weaknesses, from team member perspectives, of working with the Global Trigger Tool (GTT) method of retrospective record review to identify adverse events causing patient harm. DESIGN: A qualitative, descriptive approach with focus group interviews using content analysis. SETTING: 5 Swedish hospitals in 2011. PARTICIPANTS: 5 GTT teams, with 5 physicians and 11 registered nurses. INTERVENTION: 5 focus group interviews were carried out with the five teams. Interviews were taped and transcribed verbatim. RESULTS: 8 categories emerged relating to the strengths and weaknesses of the GTT method. The categories found were: Usefulness of the GTT, Application of the GTT, Triggers, Preventability of harm, Team composition, Team tasks, Team members’ knowledge development and Documentation. Gradually, changes in the methodology were made by the teams, for example, the teams reported how the registered nurses divided up the charts into two sets, each being read respectively. The teams described the method as important and well functioning. Not only the most important, but also the most difficult, was the task of bringing the results back to the clinic. The teams found it easier to discuss findings at their own clinics. CONCLUSIONS: The GTT method functions well for identifying adverse events and is strengthened by its adaptability to different specialties. However, small, gradual methodological changes together with continuingly developed expertise and adaption to looking at harm from a patient's perspective may contribute to large differences in assessment over time.