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The Paediatric Trigger Tool

The Paediatric Trigger Tool (PTT) measures harm caused by healthcare and adopted as part of routine monthly case note review. Through using the tool it is possible to calculate the adverse event rate and identify areas of care where most harms are occurring. It provides organisations with an unbiased measure of the incidence of iatrogenic harm experienced by their patients. It informs priorities for action and tracks improvements over time.

With the support of clinicians in nine hospitals across the UK, we have developed the UK paediatric trigger tool in order to detect adverse events in paediatric care provided in district general hospitals, acute teaching hospitals and specialist paediatric centres.

This work has built on the original work of the Institute for Healthcare Improvement, in developing the Global Trigger ToolTM for use in adults, the Acute Trigger Tool an adaption for use in UK Hospitals, and original research led by Professor Anne Matlow to develop a Canadian Paediatric Trigger Tool.

IHI Global Trigger Tool for Measuring Adverse Events was developed by IHI. "Global Trigger Tool" is a common law trademark of the Institute for Healthcare Improvement.

The Acute Trigger Tool is the approved UK version of IHI Global Trigger Tool. ®

We would like to acknowledge the following who were involved in the co-production of the UK Paediatric Trigger Tool:

Dr Peter Lachman, Great Ormond Street Hospital for Children NHS Trust

Dr Derek Burke, Medical Director, John Reid, Director of Nursing, and Dr Janet Cumberland, Clinical Associate, from Sheffield Children's NHS Foundation Trust.

Clinicians from the following Hospitals:


  • Alder Hey Children's NHS Foundation Trust
  • Birmingham Children's Hospital NHS Foundation Trust
  • Great Ormond Street Hospital for Children NHS Trust
  • Royal Manchester Children's Hospital, part of Central Manchester University Hospitals NHS Foundation Trust
  • Sheffield Children's NHS Foundation Trust
  • The Royal Free Hospital NHS Trust
  • University Hospital Bristol NHS Foundation Trust


  • NHS Greater Glasgow & Clyde
  • Royal Hospital for Sick Children, Edinburgh

Hear about how we used the model for improvement to develop the Paediatirc Trigger Tool

The Peadiatric Trigger Tool was developed in collaboration with NHS partners. Using existing trigger tool methodology, current research from a recent study in Canada (Matlow et al., Healthcare Quarterly, 8 special issue October 2005) and expert advice (Professor Anne Matlow via teleconference link), a prototype paediatric trigger tool was established at a meeting with all co-production partners. Through small scale tests of change, the tool was tested in three PDSA cycles and reviewed at three network meetings.

Paediatric Trigger ToolListen to a recorded presentation on this improvement project.




The power of co-production The power of co-production (419.60 KB) - Nicola Davey