Track and trigger in an emergency department: an observational evaluation study

Abstract

T&T in the ED is challenged by poor completion rates and numerical errors made during score calculation. However the potential for recognition of a deteriorating patient should not be ignored. The future work of the authors intends to evaluate an electronic system for automatically calculating T&T scores within the ED environment.

A ward-based time study of paper and electronic documentation for recording vital sign observations

“…Errors in EWS calculation, omission of key data, and illegible handwriting contribute to the misinterpretation of paper notes. [1,2] Computerised systems for recording vital sign observations and calculating an EWS, e-Obs systems, have previously been identified as a more effective way of identifying patients at risk of clinical deterioration. [3] The introduction of healthcare IT systems has historically been met with mixed success.…”

Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest, death or unanticipated intensive care unit admission?

“…There is evidence of error with the use of early warning scoring systems [6,[8][9][10][11], and of simpler 'calling criteria' offering advantages in ease of use and increased accuracy [6]. In particular, higher scores in NEWS are associated with higher error rates [11].…”

“…outreach or medical emergency team). Although the weightings to be summed in an EWS are small, calculation and other errors occur frequently [5][6][7][8][9][10][11]. These may impact on hospital efficiency and patient care-escalating care and monitoring for patients that do not require it, or failing to escalate care for those that do.…”

Intracranial pressure response after pharmacologic treatment of intracranial hypertension

“…32 These monitors are designed to allow clinicians to quickly assess both current status and historical trends using graphic, colored displays. Groups in cardiovascular, 33Y35 hematologic, 36 and emergency medicine 37 have developed ''track and trigger'' systems that ideally trigger medical responses to patient instability, but efforts have been hampered by concomitant increased nursing workload and calculation and trigger interpretation variability. One group reported on the implementation of an integrated monitoring system that continuously monitors multiple parameters indicative of patient cardiorespiratory stability and found their calculated instability index to correlate well with established instability criteria.…”

“…One group reported on the implementation of an integrated monitoring system that continuously monitors multiple parameters indicative of patient cardiorespiratory stability and found their calculated instability index to correlate well with established instability criteria. 37 Efforts such as these demonstrate the utility of integrating continuous data capture into smarter integrated systems that can tease out trends before they are clinically overt.…”