title: Track and trigger in an emergency department: an observational evaluation study.
abstract: OBJECTIVE
  To evaluate the utilisation of paper-based track and trigger (T&T) charts in a UK emergency department (ED).
  
  
  METHODS
  A single-centre prospective observational cohort study was conducted in the ED of a medium-sized teaching hospital. Charted vital-sign data were collected from adults attending the resuscitation room, majors or observation ward. These data were examined in parallel with clinical notes to identify 'escalation' events. For each set of vital signs, the authors calculated the T&T score retrospectively.
  
  
  RESULTS
  Data from 472 patient episodes (2965 sets of vital signs) were examined. 85.8% of patients had at least one full set of observations (CEM standard) and 60.6% had at least one T&T score documented. However, only 34.5% of observation sets had a corresponding T&T score. 20.6% of T&T score totals (1024) were incorrect, potentially preventing a 'trigger' from being recognised. 204 patient episodes had at least one recorded escalation. Physiological escalations were associated with vital-sign scores that met the triggering thresholds (98/104), while patients who had non-physiological escalations or no escalations were more likely to have scores below the triggering thresholds (88/100). Only 26.9% of physiological escalations were associated with a documented T&T score above the triggering threshold. Retrospective completion of the charts increased that figure to 94.2%.
  
  
  CONCLUSIONS
  T&T in the ED is challenged by poor completion rates and numerical errors made during score calculation. However the potential for recognition of a deteriorating patient should not be ignored. The future work of the authors intends to evaluate an electronic system for automatically calculating T&T scores within the ED environment.
authors.affiliation: Emergency Department, Oxford University Hospitals NHS Trust, Oxford, UK. sarah.wilson@ouh.nhs.uk
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Wilson
authors.forename: David
authors.initials: D
authors.lastname: Wong
authors.forename: David
authors.initials: D
authors.lastname: Clifton
authors.forename: Susannah
authors.initials: S
authors.lastname: Fleming
authors.forename: Rob
authors.initials: R
authors.lastname: Way
authors.forename: Richard
authors.initials: R
authors.lastname: Pullinger
authors.forename: Lionel
authors.initials: L
authors.lastname: Tarassenko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004282:Documentation / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies; D014218:Triage / Q000379:methods*; D006113:United Kingdom; D055986:Vital Signs