title: Lower incidence of unexpected in-hospital death after interprofessional implementation of a bedside track-and-trigger system.
abstract: BACKGROUND
  In-hospital patients may suffer unexpected death because of suboptimal monitoring. Early recognition of deviating physiological parameters may enable staff to prevent unexpected in-hospital death. The aim of this study was to evaluate short- and long-term effects of systematic interprofessional use of early warning scoring, structured observation charts, and clinical algorithms for bedside action.
  
  
  METHODS
  A prospective non-randomized controlled study of unexpected in-hospital death before and after implementation of a clinical intervention in a medical and surgical ward setting at an urban Danish university hospital. Information was obtained over three four-month study periods - a pre-interventional one in 2009 (1st March-30th June), and two postinterventional ones in 2010 (1st September-31st December) and 2011 (1st March-30th June). The incidence of unexpected patient death, the primary study outcome, was calculated as the rate of unexpected patient mortality based on in-hospital risk time.
  
  
  RESULTS
  The adjusted unexpected patient mortality rate was significantly lower during the second postinterventional study period than before the intervention, 17 versus 61 per 100 adjusted patient years (P=0.013), corresponding to a rate ratio of 0.271 (95% confidence interval (CI) 0.097-0.762). A tendency to reduced unexpected mortality was found during the first postinterventional study period (25 versus 61 per 100 adjusted patient years, P=0.053; rate ratio 0.404, CI 0.161-1.012).
  
  
  CONCLUSIONS
  Clinical intervention comprising systematic monitoring practice, early warning scoring, an observation chart, and an algorithm for bedside management, implemented by interprofessional teaching, training, and optimization of communication and collaboration, may significantly reduce unexpected in-hospital mortality.
authors: Department of Anaesthesiology, Copenhagen University Hospital, Hvidovre, Denmark; Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden.
authors: Gitte
authors: G
authors: Bunkenborg
authors: Department of Health Sciences, Lund University, and the Intensive Care Unit, Lund University Hospital, Lund, Sweden.
authors: Karin
authors: K
authors: Samuelson
authors: Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Glostrup, Denmark.
authors: Ingrid
authors: I
authors: Poulsen
authors: Head of Biostatistics, Copenhagen University Hospital, Hvidovre, Denmark.
authors: Steen
authors: S
authors: Ladelund
authors: Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden. Electronic address: jonas.akeson@med.lu.se.
authors: Jonas
authors: J
authors: Åkeson
mesh_terms: D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010348:Patient Care Team; D019095:Point-of-Care Systems; D011446:Prospective Studies
keywords: Adverse event; Algorithm; Interprofessional; Mortality rate; Observation chart; Severity scoring; Track-and-trigger system