The effect of an emergency department clinical “triggers” program based on abnormal vital signs

Abstract

Objective: To determine the effect of 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. Methods: A retrospective, separate sample, pre-post intervention study following implementation of an ED triggers program. Abnormal vital sign criteria that warranted a trigger response included: heart rate 130 beats/min, respiratory rate 30 respirations/min, systolic blood pressure <90 mm Hg, or oxygen saturation <90% on room air. The primary outcome investigated was time to physician evaluation with secondary outcomes being the time to disposition decision and time to first critical therapeutic intervention. Results: The median time to physician evaluation was reduced by 25% from 28 min to 21 min (P<0.05). The median time to disposition decision was decreased by 12% from 154 minutes to 135 minutes (P<0.05). The median time to first intervention was 46 min and 43 min (P=0.33) in the before and after groups, which did not represent a statistically significant difference. Conclusions: In our model, the implementation of an ED triggers program resulted in a modest decreased time to physician evaluation and disposition decision but not time to intervention.

Keywords

• Clinical triggers
• Abnormal vital signs
• Rapid response team