Can an emergency department clinical "triggers" program based on abnormal vital signs improve patient outcomes?
BACKGROUND
Because abnormal vital signs indicate the potential for clinical deterioration, it is logical to make emergency physicians immediately aware of those patients who present with abnormal vital signs.


OBJECTIVE
To determine if a clinical triggers program in the emergency department (ED) setting that utilized predetermined abnormal vital signs to activate a rapid assessment by an emergency physician-led multidisciplinary team had a measurable effect on inpatient hospital metrics.


METHODS
The study design was a retrospective pre and post intervention study. The intervention was the implementation of an ED clinical "triggers" program. Abnormal vital sign criteria that warranted a trigger response included: heart rate 130 beats/minutes, respiratory rate 30 breaths/minute, systolic blood pressure <90 mm Hg, or oxygen saturation <90% on room air. The primary outcome investigated was the median days admitted with secondary outcomes of median days in special care unit, in-hospital 30-day mortality and proportion of patients who required an upgrade in inpatient care level.


RESULTS
There was no difference in median days admitted for inpatient care (3.8 v. 4.0 days, p=0.21) or median days spent in a special care unit (5.0 v. 5.6 days, p=0.42) between the groups. There was no difference in the percentage of in-hospital patient deaths (6.0% v. 5.6%, p=0.66) or frequency of upgrade in level of care within 24 hours (4.9% v. 4.0%, p=0.52).


CONCLUSIONS
In our study, the implementation of an ED clinical triggers program did not result in a significant change in measured inpatient outcomes.
*Department of Medicine,Harvard Medical School,Boston,MA.
Jason
J
Imperato
†Department of Emergency Medicine,Mount Auburn Hospital,Cambridge,MA.
Tyler
T
Mehegan
Daniel J
DJ
Henning
*Department of Medicine,Harvard Medical School,Boston,MA.
John
J
Patrick
†Department of Emergency Medicine,Mount Auburn Hospital,Cambridge,MA.
Chase
C
Bushey
*Department of Medicine,Harvard Medical School,Boston,MA.
Gary
G
Setnik
*Department of Medicine,Harvard Medical School,Boston,MA.
Leon D
LD
Sanchez
D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014218:Triage; D055986:Vital Signs
Abnormal Vital Signs; Clinical Triggers; Patient Outcomes