A systematic review published in the International Journal for Quality in Health Care in November 2025 examined how well trigger tools identify adverse events when applied to medical record review. Gutierrez-Mendoza and colleagues included 100 studies from 37 countries, covering 932 hospitals and 552,623 medical records reviewed with a trigger tool. Two methods account for most of that literature. The Institute for Healthcare Improvement Global Trigger Tool was used in 75% of the studies, and the Harvard Medical Practice Study method in 15%. For the IHI Global Trigger Tool, the authors report an average positive predictive value of 54.5%, a negative predictive value of 80.9%, a sensitivity of 86.6%, and a specificity of 68.2%. For the Harvard Medical Practice Study method, the reported average positive predictive value was 43.9% and the negative predictive value 37.8%. The authors state that 66% of the 100 studies reported no predictive value at all, and that predictive values are reported in about one in seven studies. Among the studies that did report them, predictive values for individual triggers ranged from 0 to 100%. The authors state the limits of their own synthesis. No meta-analysis was conducted; the averages are arithmetic means across the studies that supplied values, and the synthesis is narrative. Only articles published in English and Spanish were included. Heterogeneity across studies limited the ability to synthesize findings meaningfully. Two of their findings bear directly on how review capacity is designed. Every included study used a two-stage review process. Two or more reviewers were involved in 86% of studies, and in 72% a physician validated the adverse events independently of the first reviewer. On automation, the authors write that digital trigger tools have the potential to reduce the time spent identifying triggers in hospitals equipped with electronic medical records, but that this approach requires the supervision of healthcare professionals to validate the findings effectively. They state that validation of adverse events will remain dependent on the expertise of physicians or other experienced healthcare professionals. HB Healthcare Safety frames the decision before health system leaders as binary: treat trigger-based detection as a screen whose output a qualified reviewer validates, or treat its output as a count and report it as found. Gutierrez-Mendoza LM, Manias E, Nicholson P. Predictive values of trigger tools for identifying adverse events in hospitalized patients using a medical record review: a systematic review. Int J Qual Health Care. 2025;37(4):mzaf119. doi.org/10.1093/intqhc/mzaf1… #HealthcareQuality #PatientSafety