title: Emergency department abnormal vital sign "triggers" program improves time to therapy.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA, USA. dmcgilli@bidmc.harvard.edu
authors.forename: Daniel C
authors.initials: DC
authors.lastname: McGillicuddy
authors.forename: Francis J
authors.initials: FJ
authors.lastname: O'Connell
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
authors.forename: Shelly A
authors.initials: SA
authors.lastname: Calder
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Mottley
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Roberts
authors.forename: Leon D
authors.initials: LD
authors.lastname: Sanchez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004635:Emergency Medicine / Q000379:methods*; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010808:Physical Examination / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage / Q000379:methods*; D055986:Vital Signs; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents