Trigger tools are used as signals to detect potential adverse events. Using the Institute for Healthcare Improvement Global Trigger Tool (GTT), one patient safety review team was unable to reproduce harm rates in a test-retest reliability study, suggesting the GTT may not be a reliable measure of harm over time. The team recommends additional test-retest studies in other hospitals.

This study used the Global Trigger Tool to review all inpatient deaths in a Norwegian hospital for evidence of adverse events. Adverse events occurred in more than a quarter of patients who died in the hospital, a significantly higher rate compared to a control group of hospitalized patients who survived. The study did not assess the preventability of deaths; prior studies have consistently found that about 5% in-hospital deaths are likely preventable.

Initial enthusiasm about the ability of the World Health Organization's surgical safety checklist to prevent harm was tempered by a subsequent study that failed to improve clinical or safety outcomes. The conflicting results of surgical checklist studies have led to concerns that checklists may lack effectiveness when care is of relatively high quality at baseline, and that poor implementation can hinder their use. In this study, the WHO checklist proved successful at improving safety outcomes when implemented across five surgical services at two academic hospitals in Norway. The checklist's success in this rigorously designed and analyzed study was likely attributable to the institution having followed a structured implementation process that had been previously demonstrated to improve safety culture in the operating room. The controversy around surgical safety checklists is discussed in a recent AHRQ WebM&M interview.