title: Vital sign abnormalities, rapid response, and adverse outcomes in hospitalized patients.
abstract: Rapid response activation (RRA), triggered chiefly by surpassing threshold vital sign abnormalities (TVSAs), is designed to intervene at the earliest point in a patient's deteriorating course. The authors aimed to quantify the incidence of TVSA among patients hospitalized on acute care units in a hospital that uses rapid response. During the course of 6 months, the authors compared adverse events (mortality, unexpected intensive care unit [ICU] transfers, and cardiopulmonary arrest) and TVSA among patients who triggered an RRA, patients with TVSAs and no RRA, and all other patients. At least 1 TVSA was recorded in 31.9% of stays and 12.2% of patient-days. RRA patients were more likely (22.5%) than other TVSA patients (7.9%) and other patients (1.8%) to have an adverse event (P < .01). Incidence varied by vital sign. During the investigation, only 2.5% of TVSA opportunities triggered an RRA. As systems engage electronic workflows, automatically triggering RRAs based solely on TVSAs could place a tremendous burden on systems.
authors.affiliation: Denver Health, Denver, CO 80204-4507, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Fagan
authors.forename: Allison
authors.initials: A
authors.lastname: Sabel
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.forename: Thomas D
authors.initials: TD
authors.lastname: MacKenzie
mesh_terms: D000328:Adult; D056902:Clinical Alarms; D004630:Emergencies; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055986:Vital Signs