Triggers study evaluates regular staff, ICU specialists

July 17, 2012

A system of care focused on the detection and systematic assessment of patients with clinical instability can yield similar outcomes as rapid response teams staffed with trained intensive care specialists, a Beth Israel Deaconess Medical Center study has found.

The analysis of 177,347 patients over a 59-month period was published online in Medicine, the journal of the Society of . Rapid Response Teams have become an important part of hospital care in recent years, sending critical care-trained responders to the bedside of decompensating patients. Most rapid response teams in the United States send a special ICU-based team of additional providers to the bedside of these patients.

"We found that a that relied on providers already assigned to a patient's care, rather than a separate ICU-based rapid response team was associated with a marked reduction in the rate of unexpected mortality," says Michael D. Howell, MD, MPH, a critical care specialist at BIDMC and Assistant Professor of Medicine at Harvard Medical School.

BIDMC launched a novel model of a rapid response team, called Triggers, in 2005. This program differs from the usual rapid response team approach because it does not add additional to the patient's care. Instead, it organizes the response of providers who were already assigned to the patient's care.

The Trigger team includes the patient's nurse, intern, respiratory therapist, and the floor's senior nurse – all of whom respond to a patient's bedside when confronted with a number of diagnostic factors, such as heart rate, blood pressure, respiratory rater, oxygen saturation or urine output charge within set parameters. A "trigger" can also be called on the concern of the nurse caring for the patient or – in recent years – the team can be directly called by patients or family members who are worried.

If an initial evaluation warrants a follow-up, a resident and the senior attending physician must be notified.

In a study of cases from 2004 to 2008, researchers found that the Triggers program resulted in a 65 percent reduction in the odds of unexpected mortality among all admitted to the hospital. The risk of overall in-hospital mortality was 5 percent lower, but this was not a statistically significant difference.

Those findings are relevant to clinicians and policymakers for two reasons.

"Our lower-staffing intensity approach produces outcomes comparable with ICU-based approaches," Howell wrote. "This approach requires no additional clinical staffing, preserves provider continuity (which may limit adverse events and respects traditional tenets of medical education."

Given issues surrounding the shortage of intensivists, who are called upon to perform out-of-ICU duties, particularly in smaller hospitals "it may be that intensivists' time is better spent with the critically ill in the ICU rather than serving as part of a rapid response team."

Explore further: Telemonitoring may not offer improved outcomes for critically ill patients

Related Stories

Telemonitoring may not offer improved outcomes for critically ill patients

May 16, 2011
Telemonitoring may offer promise for patients in remote locations without access to specially trained intensive care physicians. However, a recent study indicates telemonitoring does not offer improved clinical outcomes compared ...

Nighttime intensivist staffing and mortality in the ICU

May 21, 2012
Nighttime intensivist physician staffing in intensive care units (ICUs) with a low-intensity daytime staffing model is associated with reduced mortality, according to a new study published in the New England Journal of Medicine ...

Implementation of telemedicine intervention in ICUs associated with better outcomes for patients

May 16, 2011
Intensive care units (ICUs) that implemented a telemedicine intervention that included offsite electronic monitoring of processes and detection of nonadherence to best practices had lower hospital and ICU mortality, lower ...

Antidepressant use associated with increased mortality among critically ill patients?

May 22, 2012
Researchers at Beth Israel Deaconess Medical Center, in Boston, and the Massachusetts Institute of Technology in Cambridge, have found that critically ill patients were more likely to die if they were taking the most commonly ...

Recommended for you

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

Financial ties between researchers and drug industry linked to positive trial results

January 18, 2017
Financial ties between researchers and companies that make the drugs they are studying are independently associated with positive trial results, suggesting bias in the evidence base, concludes a study published by The BMJ ...

Best of Last Year – The top Medical Xpress articles of 2016

December 23, 2016
(Medical Xpress)—It was a big year for research involving overall health issues, starting with a team led by researchers at the UNC School of Medicine and the National Institutes of Health who unearthed more evidence that ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.