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The Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool is designed to capture adverse events in all pediatric inpatient settings by using triggers (i.e. “flags”) found in patient records, which will increase the specificity and time efficiency of medical record reviews. GAPPS has been tested in 16 hospitals across the U.S. The measure consists of both the Manual GAPPS Trigger Tool (for non-automated screens of medical records) and the Automated GAPPS Trigger Tool (for automated screens of electronic health records). The manual trigger list contains 27 triggers and the automated list contains 31 triggers. Funded through the Pediatric Quality Measures Program (PQMP) by the federal Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS), the Center of Excellence for Pediatric Quality Measurement (CEPQM) developed the Trigger Tool so that healthcare facilities can obtain pediatric patient safety data for use in internal, global, and service-specific quality improvement. GAPPS will allow for the standardized identification of adverse events to improve patient safety in pediatric settings. The GAPPS Trigger Tool is endorsed by the National Quality Forum (NQF).

Hospitalized pediatric patients are susceptible to adverse events, which can occur during 1 to 11 percent of all hospitalizations. Higher-risk pediatric populations, such as those in the pediatric intensive care units, have even higher rates with 203 adverse events per 100 patients. Voluntary incident reporting captures only 2 to 8 percent of all adverse events, and exhaustive chart review methods can be resource-intensive. An alternative approach is the use of trigger tools to detect adverse events. This methodology allows for a faster assessment than a full chart review and a greater likelihood for detection of an adverse event than voluntary reporting.

For more information about the GAPPS Trigger Tool development process and where to download the tool and instructions for its application, please see: Content, Development, and Training.

GAPPS Trigger Tool Core Team

  • Chris Landrigan, MD, MPH (Measure Co-Leader; Boston Children’s Hospital and Harvard Medical School)
  • David Stockwell, MD, MBA (Measure Co-Leader; Children’s National Medical Center)
  • Mark Schuster, MD, PhD (Kaiser Permanente, Boston Children's Hospital, and Harvard Medical School)
  • Sara Toomey, MD, MPH, MPhil, MSc (Boston Children’s Hospital and Harvard Medical School)