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Emergency Department Abnormal Vital Sign “Triggers” Program Improves Time to Therapy

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ACADEMIC EMERGENCY MEDICINE 2011; 18:483–487 © 2011 by the Society for Academic Emergency Medicine
Abstract

Background:  Implementation of rapid response systems to identify deteriorating patients in the inpatient setting has demonstrated improved patient outcomes. A “trigger” system using vital sign abnormalities to initiate evaluation by physician was recently described as an effective rapid response method.

Objectives:  The objective was to evaluate the effect of a triage‐based trigger system on the primary outcome of time to physician evaluation and the secondary outcomes of therapeutic intervention, antibiotics, and disposition in emergency department (ED) patients.

Methods:  A separate‐samples pre‐ and postintervention study was conducted using retrospective chart review of outcomes in ED patients for three arbitrarily selected 5‐day periods in 2007 (pretriggers) and 2008 (posttriggers). There were 2,165 and 2,212 charts in the pre‐ and posttriggers chart review, with 71 and 79 patients meeting trigger criteria. Trigger criteria used to identify patients at triage were: heart rate of <40 or >130 beats/min, respiratory rate of <8 or >30 breaths/min, systolic blood pressure of <90 mm Hg, and oxygen saturation of <90% on room air. Median times (in minutes) were compared between pre‐ and posttrigger groups with interquartile ranges (IQRs 25–75), with the Wilcoxon rank sum test used to determine statistical significance.

Results:  Overall median times were decreased among the posttriggers group. Median times to physician evaluation (21 minutes [IQR = 13–41 minutes] vs. 11 minutes [IQR = 5–21 minutes]; p < 0.001), first intervention (58 minutes [IQR = 20–139 minutes] vs. 26 minutes [IQR = 11–71 minutes]; p < 0.01), and antibiotics (110 minutes [IQR = 74–171 minutes] vs. 69 minutes [IQR = 23–130 minutes]; p < 0.01) were significant. Median times to disposition (177 minutes [IQR = 121–303 minutes] vs. 162 minutes [IQR = 114–230 minutes]; p = 0.18) were not significant.

Conclusions:  Implementation of an ED triggers program allows for more rapid time to physician evaluation, therapeutic intervention, and antibiotics.
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Document Type: Research Article

Affiliations: 1: From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA. 2: From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA. 3: From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA. 4: From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA.

Publication date: 01 May 2011

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