GAPPS Trigger Tool - Development

The Center of Excellence for Pediatric Quality Measurement (CEPQM) at Boston Children’s Hospital (BCH) developed the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool. The GAPPS Trigger Tool builds off of existing trigger tools, literature review, consultations with trigger tool experts, input from a stakeholder panel, and national field test results. The patient safety measure underwent a rigorous development process that includes:    

Literature Review and Expert Input

We conducted an extensive literature review on the incidence of adverse events in hospitals and on the use of different methods to detect harm from medical care. Through this process, we found that recent studies have shown that the trigger tool has very high specificity, high reliability, and higher sensitivity than other patient harm detection methods. Consequently, we used this literature review, as well as input from nationally-recognized patient safety experts, to compile a list of 78 potential triggers for a pediatric trigger tool.    

Stakeholder Panel

We conducted a stakeholder panel from top national stakeholder organizations. The panel used the RAND/UCLA Appropriateness Method, an established practice for developing health indicators, to narrow down the candidate trigger list. The panel consisted of leading physicians, scientists, and program directors from prominent healthcare organizations or institutions, including the Institute for Healthcare Improvement and the American Pediatric Association. Each panel member reviewed the candidate triggers, accompanying definitions, and potential case examples of associated adverse events and then rated the validity and feasibility of each trigger. This approach resulted in the inclusion of 54 of the initial 78 candidate triggers in the draft GAPPS Trigger Tool.

National Field Test

From June 2013 - February 2014, we tested the draft trigger tool in 16 hospitals across the United States that represented diverse geographic regions and included 8 teaching and 8 non-teaching hospitals. Ultimately, we reviewed 3,814 pediatric medical records.