Early Warning/Track-and-Trigger Systems to Detect Deterioration and Improve Outcomes in Hospitalized Patients

Abstract

As a global effort toward improving patient safety, a specific area of focus has been the early recognition and rapid intervention in deteriorating ward patients. This focus on "failure to rescue" has led to the construction of early warning/track-and-trigger systems. In this review article, we present a description of the data behind the creation and implementation of such systems, including multiple algorithms and strategies for deployment. Additionally, the strengths and weaknesses of the various systems and their evaluation in the literature are emphasized. Despite the limitations of the current literature, the potential benefit of these early warning/track-and-trigger systems to improve patient outcomes remains significant.

Addressing Patient Acuity and Nurse Staffing Issues in the Acute Care Setting: A Review of the Literature

“…Research has demonstrated that measurable physiological changes occur in patients up to 48 hours before cardiopulmonary arrest (Shiloh, Lominadze, Gong, & Savel, 2016). There are "objective parameters" that, when examined in a trending manner, can predict "physiological dysfunction" (Howard, 2016, p. 14).…”

Failure To Rescue, What Can Be Done To Prevent It?

“…There are systems that help nurses to know when to escalate care and also detect changes prior to deterioration, such as early warning scores (EWS), also known as Track and Trigger Systems (TTS) [8,10,19,20].…”

“…Multiple parameter systems are expanded versions of the single parameter ones, using a combination of abnormal signs to trigger a response. The aggregate weighted systems assign points to the degree of deviation of individual physiological variables, combining them to a score, which has thresholds for triggering [19]. In addition, many systems include the facility for triggering on a subjective basis, recognizing the importance of clinical intuition in patient assessment [18].…”

“…The efferent limb is just as important as the afferent limb, as it is the response to the trigger and initiates the escalation of care [19]. For this, the implementation of Rapid Response Teams (RRT) or Medical Emergency Teams (MET) arose as a method to provide care to patients that were deteriorating or at risk of deteriorating at their bedside [28].…”

Timely Interventions for Children with ADHD through Web-Based Monitoring Algorithms

“…Both the IOM and the Institute for Healthcare Improvement (IHI) have called for error-proofing of healthcare delivery systems to ensure early identification of potential adverse events [16,17,18]. Electronic health record (EHR)-based trigger tools have been successful in identifying potential risk of patient harm and improving intervention timeliness [1,19,20,21,22,23,24]. However, little is known about trigger tools embedded within patient- or family-reported outcome systems.…”