The Importance of Using Multiple Safety Evaluation Systems in Hospitals: A Comparison of Critical Incident Reporting System (CIRS), Assurance of Quality in Surgery (AQC), and the Global Trigger Tool (GTT)

BACKGROUND: Accurate detection of adverse events (AEs) and patient harm is fundamental for improving patient safety in hospitals. The primary objective of this study is to evaluate the sensitivity of the Institute for Healthcare Improvement (IHI), the Global Trigger Tool (GTT) in detecting adverse events compared with the Assurance of Quality in Surgery (AQC) surgical database and the voluntary Critical Incident Reporting System (CIRS) in a Swiss hospital setting. Specifically, we aim to quantify the detection gap between these 3 systems. METHODS: A retrospective review was conducted over a 12-month period between January 1st and December 31st, 2024. Analyzing data from 3 distinct surveillance methods: (1) Voluntarily submitted reports via the Critical Incident Reporting System (CIRS) were reviewed for all reported incidents; (2) For the GTT, 20 monthly randomly selected medical records of surgical inpatients (aged 18+, minimum 24-h stay, excluding orthopedics) were reviewed monthly; (3) Assurance of Quality in Surgery (AQC) data was manually entered for all operated surgical inpatients (excluding orthopedics), with rigorous quality checks performed by the authors. The findings from these systems were then compared. RESULTS: An evaluation of CIRS for 2024 revealed only one reported case within the surgical department. Concurrently, AQC statistics indicated 283 completed surgical inpatient procedures, with 17 (6.01%) resulting in complications (surgical and nonsurgical). Furthermore, among 596 stationary patients treated in 2024, the GTT identified 58 patients (9.73%) with at least one AE. Number of overlapping cases between the GTT and the AQC reporting systems was 14. CONCLUSION: AQC is a particularly valuable tool, especially for operated patients. The Global Trigger Tool (GTT) boasts a wider range of applicability. Its strength lies in its ability to systematically identify potential adverse events through the review of patient records of operated and not operated patients. Sole reliance on voluntary reporting is insufficient for comprehensive adverse event detection. We advise the hospitals to adopt an additional system to complement the voluntary reporting CIRS system.