# Multicenter Study of the Emergency Department Trigger Tool

> **NIH AHRQ R01** · WASHINGTON UNIVERSITY · 2020 · $398,528

## Abstract

Existing methods for surveillance of patient harm in the ED setting are inadequate, without any meaningful
change in decades. Trigger tools, popularized by the Institute for Healthcare Improvement’s Global Trigger
Tool, have been developed for multiple clinical areas and are used across the world, outperform traditional
approaches for surveillance of adverse events. These tools use a two-tiered review process where a nurse
screens records for triggers (predefined findings that make the presence of an AE more likely) and reviews
records with triggers for AEs, discarding those without triggers. We developed a consensus-based ED trigger
tool (EDTT) using a multicenter, transdisciplinary modified Delphi approach, subsequently pilot testing this in a
multicenter fashion with encouraging results. This was followed by a recently completed, AHRQ-funded single
center study to automate, refine and validate this tool. This study demonstrated that the EDTT is a high-yield
and efficient instrument for identifying adverse events in the ED. The present study will evaluate the refined,
automated EDTT), in a multicenter study. We will evaluate the EDTT’s generalizability and robustness at three
sites with large emergency departments, with a planned in-depth review of 9,000 ED admissions. We will use
natural language processing of electronic medical record narratives and machine learning to improve the EDTT
efficiency in trigger detection and AE discovery. We will establish the basis for a wider use and prepare for
scalability and usability of the tool, creating standardized, streamlined and free online training materials, and
by evaluating the tool in a real-world manner consistent with intended use.

## Key facts

- **NIH application ID:** 10098792
- **Project number:** 1R01HS027811-01
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Richard T Griffey
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $398,528
- **Award type:** 1
- **Project period:** 2020-09-30 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10098792

## Citation

> US National Institutes of Health, RePORTER application 10098792, Multicenter Study of the Emergency Department Trigger Tool (1R01HS027811-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10098792. Licensed CC0.

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