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

ObjectiveTo 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.MethodsA 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 <40 or >130 beats/min, respiratory rate <8 or >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.ResultsThe 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.ConclusionsIn 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.