Automatic triangulation, right here, right now

We’ve been working on an exciting new development which I wanted to share. The CRAB Medical module has taken a leap forward with the automatic triangulation of all 32 of the triggers in the global trigger tool (UK version).


Trigger tools help identify adverse effects and areas for improvement by auditing a small sample of patient notes regularly. The US Institute of Healthcare Improvement (IHI) refined this process and developed the global trigger tool to quantify adverse events more generally

using a simple and replicable process. The global trigger tool has become internationally recognised as a method for tracking avoidable harm. However, one of the drawbacks associated with trigger tools in general is that it is a paper review of a randomly sampled set of notes – and the number of reviews is small.


CRAB Medical now produces reliable and automated tracking of all GTT triggers. Getting to this stage involved a four-year manual review of 30,000 sets of notes revealed combinations of existing clinical codes closely associated with the presence of each of the triggers. This was then validated against 1.2m patient records and has been subsequently validated externally by NHS organisations.


CRAB Medical reports on trigger events for all patients, by specialty, by physician, and over time to give a comprehensive picture of quality and trends in medical care.


If you would like to find out more about CRAB Medical, please contact:


Dr Mark Ratnarajah

020 8144 6967


  • 30 May, 2018
  • Claire Bale

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