Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

Imperato, Jason; Mehegan, Tyler; Henning, Daniel J.; Patrick, John D.; Bushey, Chase; Setnik, Gary S.; Sánchez, León D.

doi:10.1017/cem.2016.365

Cited by 4 publications

(24 citation statements)

References 16 publications

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“…Recent work has focused on the development of predictive tools based on ED vital signs to assist EPs in identifying patients at risk for decompensation 8,9. One example, the PeRRT (Predicting Early Rapid Response Team) score, incorporates vital signs (among other data) to predict which patients would trigger a rapid response activation during the first 12 hours of admission 10.…”

Section: Discussionmentioning

confidence: 99%

Association of Vital Signs and Process Outcomes in Emergency Department Patients

Hodgson

Poterack

et al. 2019

WestJEM

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Introduction We sought to determine the association of abnormal vital signs with emergency department (ED) process outcomes in both discharged and admitted patients. Methods We performed a retrospective review of five years of operational data at a single site. We identified all visits for patients 18 and older who were discharged home without ancillary services, and separately identified all visits for patients admitted to a floor (ward) bed. We assessed two process outcomes for discharged visits (returns to the ED within 72 hours and returns to the ED within 72 hours resulting in admission) and two process outcomes for admitted patients (transfer to a higher level of care [intermediate care or intensive care] within either six hours or 24 hours of arrival to floor). Last-recorded ED vital signs were obtained for all patients. We report rates of abnormal vital signs in each group, as well as the relative risk of meeting a process outcome for each individual vital sign abnormality. Results Patients with tachycardia, tachypnea, or fever more commonly experienced all measured process outcomes compared to patients without these abnormal vitals; admitted hypotensive patients more frequently required transfer to a higher level of care within 24 hours. Conclusion In a single facility, patients with abnormal last-recorded ED vital signs experienced more undesirable process outcomes than patients with normal vitals. Vital sign abnormalities may serve as a useful signal in outcome forecasting.

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Section: Discussionmentioning

confidence: 99%

Association of Vital Signs and Process Outcomes in Emergency Department Patients

Hodgson

Poterack

et al. 2019

WestJEM

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“…Thirty-two studies were single site studies [19,20,[32][33][34][35][36][37][38][39][40][41][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. The countries of origin were Turkey (n = 8) [33, 34, 37-39, 42, 45, 48], United States (n = 3) [41,43,49], United Kingdom (n = 3) [44,50,51], Australia (n = 3) [19,20,57], China (n = 3) [35,60,62], Italy (n = 2) [58,61], Indonesia (n = 2) [46,47] and one study each from Finland [32], De...…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Only six studies explicitly reported the response to ED patients identified as deteriorating [19,20,44,49,52,58].…”

Section: Response To Clinical Deterioration In Ed Patientsmentioning

confidence: 99%

“…A study of 2965 sets of vital signs from 472 ED episodes of care showed 85.8% of patients had documentation of ≥1 complete set of six vital signs: 87.6% sets of vital signs contained admission or die in hospital than patients in whom this system was not activated [19]. The other study reported no difference in ICU admission, hospital length of stay or 30-day mortality following implementation of ED triggers and an escalation of care response [49].…”

Section: Completion Of Documentationmentioning

confidence: 99%

“…• In-hospital deaths (n = 1) [19] • no difference in 30-day mortality after implementation of ED triggers [49], and…”

Section: Track and Trigger Scoringmentioning

confidence: 99%

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Systems for recognition and response to deteriorating emergency department patients: a scoping review

Considine

Fry

Curtis

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Assessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care. The aim of this scoping review was to assess the extent, range and nature of published research related to formal systems for recognising and responding to clinical deterioration in emergency department (ED) patients. Materials and methods We conducted a scoping review according to PRISMA-ScR guidelines. MEDLINE complete, CINAHL and Embase were searched on 07 April 2021 from their dates of inception. Human studies evaluating formal systems for recognising and responding to clinical deterioration occurring after triage that were published in English were included. Formal systems for recognising and responding to clinical deterioration were defined as: i) predefined patient assessment criteria for clinical deterioration (single trigger or aggregate score), and, or ii) a predefined, expected response should a patient fulfil the criteria for clinical deterioration. Studies of short stay units and observation wards; deterioration during the triage process; system or score development or validation; and systems requiring pathology test results were excluded. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, system tested, outcomes examined, and major findings. Results After removal of duplicates, there were 2696 publications. Of these 33 studies representing 109,066 patients were included: all were observational studies. Twenty-two aggregate scoring systems were evaluated in 29 studies and three single trigger systems were evaluated in four studies. There were three major findings: i) few studies reported the use of systems for recognising and responding to clinical deterioration to improve care of patients whilst in the ED; ii) the systems for recognising clinical deterioration in ED patients were highly variable and iii) few studies reported on the ED response to patients identified as deteriorating. Conclusion There is a need to re-focus the research related to use of systems for recognition and response to deteriorating patients from predicting various post-ED events to their real-time use to improve patient safety during ED care.

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AI applications in diagnostic technologies and services

Catania¹

2021

Foundations of Artificial Intelligence in Healthcare and Bioscience

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Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

Cited by 4 publications

References 16 publications

Association of Vital Signs and Process Outcomes in Emergency Department Patients

Association of Vital Signs and Process Outcomes in Emergency Department Patients

Systems for recognition and response to deteriorating emergency department patients: a scoping review

AI applications in diagnostic technologies and services

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