The Accuracy of Trigger Tools to Detect Preventable Adverse Events in Primary Care: A Systematic Review

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To understand the ability of trigger tools to detect preventable adverse events (pAEs) in the primary care outpatient setting using the Institute for Healthcare Improvement's (IHI) Outpatient Adverse Event Trigger Tool (IHI Tool).


The OVID MEDLINE and OVID MEDLINE In-process and non-Indexed citations databases were queried using controlled vocabulary and Medical Subject Headings related to the concepts “primary care” and “adverse events.” Included articles were conducted in the outpatient setting, used at least 1 of the triggers identified in the IHI Tool, and identified pAEs of any type. Articles were selected for inclusion based first on assessment of titles then abstracts by 2 trained reviewers independently, followed by full text review by 2 authors.


Our search identified 6435 unique articles, and we included 15 in our review. The most common studied trigger was laboratory abnormalities. The most common pAEs were medication errors followed by unplanned hospitalizations. The effectiveness of triggers in identifying AEs varied widely.


There is insufficient data on the IHI Tool and its use to identify pAEs in the general real-world outpatient setting. Health care providers of the primary care setting may benefit from better trigger tools and other methods to help them detect pAEs. More research is needed to further evaluate the effectiveness of trigger tools to reduce barriers of cost and time and improve patient safety.

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