Does the use of a “track and trigger” warning system reduce mortality in trauma patients?

Patel, Mahomed; Jones, Meghan A.; Jiggins, M; Williams, S.

doi:10.1016/j.injury.2011.05.030

Cited by 32 publications

(21 citation statements)

References 17 publications

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“…218 The other study demonstrated a significant difference between control wards and intervention wards (introduction of a critical care outreach service) with all patients (OR, 0.70; 95% CI, 0.50-0.97), and matched randomized patients (OR, 0.52; 95% CI, 0.32-0.85). 219 Of the 33 nonrandomized studies reporting mortality, no studies reported statistically significant worse outcomes for the intervention; 15 studies with no adjustment demonstrated no significant improvement [220][221][222][223][224][225][226][227][228][229][230][231][232][233][234] ; 6 studies with no adjustment demonstrated significant improvement [235][236][237][238][239][240] ; 1 study with no adjustment reported on rates, which improved with MET, but did not report on significance 241 ; 1 study with no adjustment demonstrated significant improvement for medical patients but not surgical patients (combined significance not reported) 242 ; 4 studies with adjustment demonstrated significant improvement both before and after adjustment 243,244,250,252 ; 2 studies with adjustment demonstrated no significant improvement both before and after adjustment 245,246 ; 2 studies with adjustment demonstrated significant improvement before adjustment but not after adjustment 247,251 ; 1 study with adjustment demonstrated significant improvement before adjustment but not after adjustment 27 ; 1 study that reported on both unexpected mortality and overall mortality showed significant improvement both before and after adjustment for unexpected mortality but no significant improvement both before and after adj...…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 8: Education, Implementation, and Teams

et al. 2015

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Section: Consensus On Sciencementioning

confidence: 99%

Part 8: Education, Implementation, and Teams

et al. 2015

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“…Early Warning Scores (EWS) are an intervention to reduce FTR events . Staff input physiological values for heart rate, respiratory rate, peripheral oxygen levels, and blood pressure, which are scored based on level of derangement .…”

Section: Introductionmentioning

confidence: 99%

A qualitative exploration of escalation of care in the acute ward setting

Ede

Jeffs

Vollam

et al. 2019

Nursing in Critical Care

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Background: "Failure to Rescue" includes failing to prevent avoidable patient deterioration and death. Despite its use, delays in care escalation still affect patient outcomes.Aims and Objective: The aim of this qualitative service evaluation was to map the barriers and facilitators to the escalation of care in the acute ward setting and identify those that are modifiable.Design: A total of 55 hours of qualitative observations were completed to capture care escalation events. These were conducted at two hospital sites in one National Health Service trust.Methods: Observations were iterative, with research team meetings being used to discuss the data and future methods. Field notes were analysed thematically by two researchers, extracting data on barriers and facilitators to escalation of care. Results: Clinical nursing staff challenged the sensitivity and specificity of Early Warning Scores, describing tool failings in certain clinical scenarios. Staff did not escalate based on the alerting Early Warning Scores alone but used other clinical factors, such as bleeding, which are not necessarily captured in the scoring systems. Staff frequently did not re-escalate low-level scores. Patient and non-patient factors identified as posing barriers to escalation were complex care needs, patient outlier status, and involvement of multiple care teams. Factors negatively affecting the chain of communication during escalation were team tension, staffing levels, and inadequate handover. Conclusion: This service evaluation identified barriers and facilitators to the escalation of care in the acute ward setting. Unlike other studies, we found that re-escalation or tracking of deterioration was problematic. Patients identified as being at a higher risk of escalation failure included complex patients, outliers, and patients with multiple care teams. Relevance to clinical practice: This service evaluation demonstrates continuing health care communication barriers. Patient groups (complex patients and outliers) risk process failures during escalation. This can be applied in clinical practice by staff anticipating problems in these patients, documenting clear escalation pathways. K E Y W O R D S acute ward, deterioration, escalation of care, observations, qualitative

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“…A RRT typically consist of medical and nursing staff with critical care skills that provide timely treatment to support the deteriorating patient on the ward . However, evidence for the efficacy of EWS and RRT systems at reducing in‐hospital mortality is equivocal . The management of critical illness remains a problem as some patients who are deteriorating continue to go unrecognized and appropriate, timely action is not always taken…”

Section: Introductionmentioning

confidence: 99%

Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review

Albutt

O’Hara

Conner

et al. 2016

Health Expectations

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BackgroundMeasures exist to improve early recognition of, and response to, deteriorating patients in hospital. However, deteriorating patients continue to go unrecognized. To address this, interventions have been developed that invite patients and relatives to escalate patient deterioration to a rapid response team (RRT).ObjectiveTo systematically review articles that describe these interventions and investigate their effectiveness at reducing preventable deterioration.Search strategyFollowing PRISMA guidelines, four electronic databases and two web search engines were searched to identify literature investigating patient and relative led escalation.Inclusion criteriaArticles investigating the implementation or use of systems involving patients and relatives in the detection of clinical patient deterioration and escalation of patient care to address any clinical or non‐clinical outcomes were included. Articles’ eligibility was validated by a second reviewer (20%).Data extractionData were extracted according to pre‐defined criteria.Data synthesisNarrative synthesis was applied to included studies.Main resultsNine empirical studies and 36 grey literature articles were included in the review. Limited studies were conducted to establish the clinical effectiveness of patient and relative led escalation. Instead, studies investigated the impact of this intervention on health‐care staff and available resources. Although appropriate, this reflects the infancy of research in this area. Patients and relatives did not overwhelm resources by activating the RRT. However, they did activate it to address concerns unrelated to patient deterioration.ConclusionsActivating a RRT may not be the most appropriate or cost‐effective method of resolving non‐life‐threatening concerns.

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Does the use of a “track and trigger” warning system reduce mortality in trauma patients?

Cited by 32 publications

References 17 publications

Part 8: Education, Implementation, and Teams

Part 8: Education, Implementation, and Teams

A qualitative exploration of escalation of care in the acute ward setting

Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review

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