Emergency Department Abnormal Vital Sign “Triggers” Program Improves Time to Therapy

Authors

  • Daniel C. McGillicuddy MD,

    1. From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA.
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  • Francis J. O’Connell MD,

    1. From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA.
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  • Nathan I. Shapiro MD, MPH,

    1. From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA.
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  • Shelly A. Calder RN,

    1. From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA.
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  • Lawrence J. Mottley MD,

    1. From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA.
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  • Jonathan C. Roberts MD,

    1. From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA.
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  • Leon D. Sanchez MD, MPH

    1. From the Beth Israel Deaconess Medical Center (FJO, SAC, JCR), Boston, MA; Harvard Affiliated Emergency Medicine Residency (FJO, JCR), Boston, MA; the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (DCM, NIS, LJM, LDS), Boston, MA; and the Department of Medicine, Harvard Medical School (DCM, NIS, LJM, LDS), Boston, MA.
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  • Presented at the Society for Academic Emergency Medicine annual conference, Phoenix, AZ, June 2010.

  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: Eddy Lang, MD.

  • [Correction added after online publication 26-Apr-2011: Dr. O’Connell’s name has been corrected.]

Address for correspondence: Daniel C. McGillicuddy, MD; e-mail: dmcgilli@bidmc.harvard.edu. Reprints will not be available.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:483–487 © 2011 by the Society for Academic Emergency Medicine

Abstract

Background:  Implementation of rapid response systems to identify deteriorating patients in the inpatient setting has demonstrated improved patient outcomes. A “trigger” system using vital sign abnormalities to initiate evaluation by physician was recently described as an effective rapid response method.

Objectives:  The objective was to evaluate the effect of a triage-based trigger system on the primary outcome of time to physician evaluation and the secondary outcomes of therapeutic intervention, antibiotics, and disposition in emergency department (ED) patients.

Methods:  A separate-samples pre- and postintervention study was conducted using retrospective chart review of outcomes in ED patients for three arbitrarily selected 5-day periods in 2007 (pretriggers) and 2008 (posttriggers). There were 2,165 and 2,212 charts in the pre- and posttriggers chart review, with 71 and 79 patients meeting trigger criteria. Trigger criteria used to identify patients at triage were: heart rate of <40 or >130 beats/min, respiratory rate of <8 or >30 breaths/min, systolic blood pressure of <90 mm Hg, and oxygen saturation of <90% on room air. Median times (in minutes) were compared between pre- and posttrigger groups with interquartile ranges (IQRs 25–75), with the Wilcoxon rank sum test used to determine statistical significance.

Results:  Overall median times were decreased among the posttriggers group. Median times to physician evaluation (21 minutes [IQR = 13–41 minutes] vs. 11 minutes [IQR = 5–21 minutes]; p < 0.001), first intervention (58 minutes [IQR = 20–139 minutes] vs. 26 minutes [IQR = 11–71 minutes]; p < 0.01), and antibiotics (110 minutes [IQR = 74–171 minutes] vs. 69 minutes [IQR = 23–130 minutes]; p < 0.01) were significant. Median times to disposition (177 minutes [IQR = 121–303 minutes] vs. 162 minutes [IQR = 114–230 minutes]; p = 0.18) were not significant.

Conclusions:  Implementation of an ED triggers program allows for more rapid time to physician evaluation, therapeutic intervention, and antibiotics.

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