There are several methodological considerations when continuing the development of trigger tool methodology that we want to raise.
This paper represents the largest study of paediatric harm using trigger tool methodology in the UK.
However, we made these modifications to the trigger tool methodology precisely to increase the likelihood of learning from AEs.
Trigger tool methodology operationalises the use of a list of triggers to allow institutions to employ an AE identification strategy previously only available in research settings.
This study develops the trigger tool methodology for pediatric care in a study conducted in a large children's hospital setting covering a wide range of care.
This intensified surveillance strategy optimally applies trigger tool methodology in order to increase detection of AEs, improve judgements of preventability and provide a richer understanding of contributing factors.
DS developed the spiked trigger averaging methodology, worked with RAC and EJM in developing and implementing the motor unit protocol, and contributed to the manuscript preparation.
Reviewers were trained in trigger tool methodology either by experts at the NHS Institute or by using online resources with telephone support.
To overcome limitations associated with retrospective AE detection methods, we hypothesised that an augmented trigger tool methodology called 'prospective clinical surveillance' 27 29 would foster the identification of factors contributing to AEs that could inform improvement initiatives.
It is likely that not all adverse events were detected with the real-time registration, and we did not compare the results of the registration with other promising new methods such as the trigger tool methodology [ 9].
