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

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.