A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients.
OBJECTIVE
To determine whether the introduction of a multi-faceted intervention (newly designed ward observation chart, a track and trigger system and an associated education program, COMPASS) to detect clinical deterioration in patients would decrease the rate of predefined adverse outcomes.


METHODS
A prospective, controlled before-and-after intervention of trial was conducted in all consecutive adult patients admitted to four medical and surgical wards during a 4 month period, 1157 and 985, respectively. A sub-group of patients underwent vital sign and medical review analysis pre-intervention (427) and post-intervention (320). The outcome measures included: number of unplanned admissions to the intensive care unit (ICU), Medical Emergency Team (MET) reviews and unexpected hospital deaths, vital sign documentation frequency and incidence of a medical review following clinical deterioration. This study is registered, ACTRN12609000808246.


RESULTS
Reductions were seen in unplanned admissions to ICU (21/1157 [1.8%] vs. 5/985 [0.5%], p=0.006) and unexpected hospital deaths (11/1157 [1.0%] vs. 2/985 [0.2%], p=0.03) during the intervention period. Medical reviews for patients with significant clinical instability (58/133 [43.6%] vs. 55/79 [69.6%] p<0.001) and number of patients receiving a MET review increased (25/1157 [2.2%] vs. 38/985 [3.9%] p=0.03) during the intervention period. Mean daily frequency of documentation of all vital signs increased during the intervention period (3.4 [SE 0.22] vs. 4.5 [SE 0.17], p=0.001).


CONCLUSIONS
The introduction of a multi-faceted intervention to detect clinical deterioration may benefit patients through increased monitoring of vital signs and the triggering of a medical review following an episode of clinical instability.
Mitchell
I A
IA
The Canberra Hospital, Department of Intensive Care, Yamba Drive, Canberra, Garran, Australian Capital Territory, Australia. Imogen.mitchell@act.gov.au
McKay
H
H
Van Leuvan
C
C
Berry
R
R
McCutcheon
C
C
Avard
B
B
Slater
N
N
Neeman
T
T
Lamberth
P
P
D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D042241:Early Diagnosis; D018479:Early Intervention, Educational; D004496:Education, Continuing; D005260:Female; D006282:Health Personnel / Q000193:education; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000706:statistics & numerical data; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010820:Physicians; D011446:Prospective Studies; D055986:Vital Signs