Early Warning System
| Status: | Completed |
|---|---|
| Conditions: | Cancer, Cancer, Chronic Obstructive Pulmonary Disease, Insomnia Sleep Studies, Cardiology, Pulmonary, Diabetes |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology, Oncology, Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - 100 |
| Updated: | 11/1/2018 |
| Start Date: | February 2013 |
| End Date: | May 2013 |
Comparing an Early Warning Alert With a Standardized Triage Intervention to Standard Care for the Management of Hospitalized Patients on General Hospital Wards.
The study will begin in 2013 whereby patients having an early warning system (EWS) alert will
be randomized to be seen by the rapid response team (RRT) for triage versus usual care. A RRT
is usually made up of a nurse and/or a physician who respond to a requested activation of the
RRT (called an "ACT"). The intervention will occur as follows:
be randomized to be seen by the rapid response team (RRT) for triage versus usual care. A RRT
is usually made up of a nurse and/or a physician who respond to a requested activation of the
RRT (called an "ACT"). The intervention will occur as follows:
The study will begin in 2013 whereby patients having an early warning system (EWS) alert will
be randomized to be seen by the rapid response team (RRT) for triage versus usual care. A RRT
is usually made up of a nurse and/or a physician who respond to a requested activation of the
RRT (called an "ACT"). The intervention will occur as follows:
1. Real-time monitoring of the eight general hospital wards (GHWs)((10100, 10200,
11100,11200, 12100, 12200, 14400, 14500)will occur 24 hours daily. Through multiple past
collaborative efforts and studies involving interventions at BJH, informatics personnel
have already demonstrated that they can accomplish this task using their computing and
algorithmic resources. The prediction tool (PT) employed is a validated PT aimed at
identifying any form of clinical deterioration occurring on a GHW requiring ICU transfer
or leading to patient death.
2. Patients meeting the prediction criteria for an increased risk of clinical deterioration
will be identified on the GHWs. An automated text message will be generated that
provides the patient's name, their room number, the date and time of the message, and
text indicating that they meet the criteria for risk of deterioration. Messages will
only be generated for patients assigned to the intervention group.
3. The EWS text message will be sent to the on-call RRT nurse's phone. These are phones
that are transferred from one RRT nurse to the other as changes of shift occur. It is
their primary means of communicating with the hospital.
4. The RRT nurse for the intervention patients will go into the flagged patient's room
within 10 to 15 minutes of receiving the message and perform a clinical assessment.
Based on the RRT nurse's assessment either no additional action need occur or he/she
will call either the physician on duty or activate an ACT as well as apply the "four
D's", which was internally established at Barnes-Jewish Hospital (BJH) for treatment of
patients on GHWs identified to have impending clinical deterioration. The four "D's"
refer to the following: Discuss level of care, Drugs for treatment (e.g., antibiotics),
Diagnostics (lab tests, cultures), and Damage control (e.g., use of intravenous fluids,
oxygen).
be randomized to be seen by the rapid response team (RRT) for triage versus usual care. A RRT
is usually made up of a nurse and/or a physician who respond to a requested activation of the
RRT (called an "ACT"). The intervention will occur as follows:
1. Real-time monitoring of the eight general hospital wards (GHWs)((10100, 10200,
11100,11200, 12100, 12200, 14400, 14500)will occur 24 hours daily. Through multiple past
collaborative efforts and studies involving interventions at BJH, informatics personnel
have already demonstrated that they can accomplish this task using their computing and
algorithmic resources. The prediction tool (PT) employed is a validated PT aimed at
identifying any form of clinical deterioration occurring on a GHW requiring ICU transfer
or leading to patient death.
2. Patients meeting the prediction criteria for an increased risk of clinical deterioration
will be identified on the GHWs. An automated text message will be generated that
provides the patient's name, their room number, the date and time of the message, and
text indicating that they meet the criteria for risk of deterioration. Messages will
only be generated for patients assigned to the intervention group.
3. The EWS text message will be sent to the on-call RRT nurse's phone. These are phones
that are transferred from one RRT nurse to the other as changes of shift occur. It is
their primary means of communicating with the hospital.
4. The RRT nurse for the intervention patients will go into the flagged patient's room
within 10 to 15 minutes of receiving the message and perform a clinical assessment.
Based on the RRT nurse's assessment either no additional action need occur or he/she
will call either the physician on duty or activate an ACT as well as apply the "four
D's", which was internally established at Barnes-Jewish Hospital (BJH) for treatment of
patients on GHWs identified to have impending clinical deterioration. The four "D's"
refer to the following: Discuss level of care, Drugs for treatment (e.g., antibiotics),
Diagnostics (lab tests, cultures), and Damage control (e.g., use of intravenous fluids,
oxygen).
Inclusion Criteria:
- Patients hospitalized on the General Hospitals Wards of Barnes-Jewish Hospital.
Exclusion Criteria:
- Patients with a do-not-resuscitate order,
- Patients not expected to survive their hospitalization.
We found this trial at
1
site
Saint Louis, Missouri 63110
Principal Investigator: Marin Kollef, MD
Phone: 314-454-8764
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