Table 2

Safer Dx e-trigger tool development process

e-trigger tool development steps	Stakeholders involved	Example
Identify and prioritise diagnostic error of interest.	Organisational leadership and patient safety personnel	Delays in follow-up of lung nodules identified as a patient safety concern
Operationally define criteria to detect diagnostic error.	Clinicians and staff involved in diagnostic process and patient safety personnel	Trigger development team defines delay as a patient with a lung nodule on a chest imaging, but no repeat imaging or specialty visit within 30 days.
Determine potential data sources.	Informaticists, IT/programmers and data warehouse personnel	Team identifies necessary structured data elements for imaging results and specialty visits within local clinical data warehouse.
Construct e-trigger algorithm.	Clinicians and staff involved in diagnostic process, informaticists, IT/programmers and data warehouse personnel	Programmer develops electronic query based on operational definition of delayed lung nodule follow-up.
Test e-trigger on data source and review medical record.	Clinicians and staff involved in diagnostic process, informaticists, IT/programmers and data warehouse personnel	Triggers are applied to data warehouse and clinicians perform chart reviews on 50 randomly selected records from those identified by the trigger.
Assess e-trigger algorithm performance.	Clinicians and staff involved in diagnostic process, informaticists and patient safety personnel	Positive and negative predictive values, sensitivity and specificity of the trigger are calculated to understand the trigger’s performance.
Iteratively refine e-trigger algorithm to improve performance.	Clinicians and staff involved in diagnostic process, informaticists, IT/programmers and patient safety personnel	Trigger development team determines terminal illness to be a major cause of false positive results and adds this to the exclusion criteria.

IT, information technology.