Vital Sign Abnormalities, Rapid Response, and Adverse Outcomes in Hospitalized Patients

Abstract

Rapid response activation (RRA), triggered chiefly by surpassing threshold vital sign abnormalities (TVSAs), is designed to intervene at the earliest point in a patient's deteriorating course. The authors aimed to quantify the incidence of TVSA among patients hospitalized on acute care units in a hospital that uses rapid response. During the course of 6 months, the authors compared adverse events (mortality, unexpected intensive care unit [ICU] transfers, and cardiopulmonary arrest) and TVSA among patients who triggered an RRA, patients with TVSAs and no RRA, and all other patients. At least 1 TVSA was recorded in 31.9% of stays and 12.2% of patient-days. RRA patients were more likely (22.5%) than other TVSA patients (7.9%) and other patients (1.8%) to have an adverse event (P < .01). Incidence varied by vital sign. During the investigation, only 2.5% of TVSA opportunities triggered an RRA. As systems engage electronic workflows, automatically triggering RRAs based solely on TVSAs could place a tremendous burden on systems.

Vital signs monitoring to detect patient deterioration: An integrative literature review

“…found bradypnoea (< 6 breaths/min) to be the strongest predictor for adverse event. In contrast, tachypnoea was reported to be the strongest predictor in the other two reviewed papers …”

“…Evidence from quantitative studies indicated that vital signs abnormalities occur in patients multiple hours preceding deterioration. Altered RR was regarded as the most significant predictor of deterioration . Buist et al .…”

“…measured cardiopulmonary arrest. Fagan et al . employed both of these outcome measures in addition to unexpected ICU transfers.…”

“…Although continuous vital signs monitoring can potentially improve detection of deteriorating vital signs, Gross et al . and Fagan et al . were doubtful of the frequency of alarm loads generated and their clinical significance.…”

Strengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients

“…In most cases, these adverse events were preceded by signs of deterioration 2 3. The timely detection and appropriate interventions are crucial in providing safe and quality care to a deteriorating patient 4.…”