Features of the triggering of the yellow code and factors associated with the occurrence of adverse events

Abstract

Objective: to analyze the characteristics of the activation of the yellow code in wards and identify the factors associated with adverse events after the Rapid Response Team. Methods: a cross-sectional study with retrospective analysis of medical records of adults admitted to medical or surgical clinic wards of the University Hospital of São Paulo. Results: among the 91 patients, the most frequent signs of triggers (n=107) were peripheral oxygen saturation of less than 90% (40.2%) and hypotension (30.8%). Regarding the associated factors the research identified each minute of attendance of the Rapid Response Team in the wards increased by 1.2% odds of adverse events (twenty-four unplanned admission in the ICU and one cardiac arrest) in the sample (p=0.014). Conclusions: decreased oxygen saturation and hypotension were the main reasons for the triggering, and the length of care was associated with the frequency of adverse events.

Using a Clinical Triggers System to Improve Early Recognition of Clinical Changes

“…Studies on surveillance modalities and interventions have noted common themes and factors that contribute to improved delivery of care and patient outcomes, despite variations in approaches. 2,4,6,8,10 Early provision of care requires 3 critical areas of intervention: recognizing the change, relaying the information, and reacting with appropriate and timely treatment. 4,6,8,10,13 Using a comprehensive strategy of surveillance and response was recommended over processes that used a single or limited interventions.…”

“…2,4,6,8,10 Early provision of care requires 3 critical areas of intervention: recognizing the change, relaying the information, and reacting with appropriate and timely treatment. 4,6,8,10,13 Using a comprehensive strategy of surveillance and response was recommended over processes that used a single or limited interventions. 4 Therefore, the clinical triggers project's implementation of a trigger activation system with clear-cut standard physical markers indicating a positive trigger, including nurse concern, alongside the use of Situation-Background-Assessment-Recommendation communication structures and handoff tools, represents a comprehensive approach to improving the delivery of care and patient outcomes.…”

“…2,10,14 Although respiratory and cardiac issues were found to be leading causes for RRT calls, nurse concern was also a frequent reason for activation. 2,3,6 The clinical triggers system includes a "marked nursing concern" trigger, which may help RNs feel more confident in acting upon their intuition and contacting the provider to the bedside. Nurse concern is a valuable tool for identifying patient condition and should be used alongside other surveillance modalities.…”

“…12,13 The clinical triggers system provides RNs with standardized parameters to observe and develop patterns to recognize, a communication format, and a defined response plan to overcome hesitancy in notification and instill confidence to advocate for timely evaluation. 6,8,10 Increased awareness to changes in temperature as a trigger was identified. The RNs responded to new-onset or worsening febrile conditions greater than 38.3°C or changes to temperature less than 36°C as early, serious symptoms of potential patient deterioration, including systemic inflammatory response syndrome and sepsis, requiring urgent attention.…”

“…Nurse concern describes when the nurse notices that something is not right with the patient and may be in the absence of physiologic changes. 2,6,14 Fourth, providers were inconsistent in assessing patients at the bedside and often defaulted to managing the clinical concern over the telephone. A standard process was needed to escalate the concern and have the provider perform a timely bedside assessment.…”