A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients

• Published in: Resuscitation 2010-06, Vol.81 (6), p.658-666
• Main Authors: Mitchell, I.A, McKay, H, Van Leuvan, C, Berry, R, McCutcheon, C, Avard, B, Slater, N, Neeman, T, Lamberth, P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac arrest; Critical Illness - therapy; Early Diagnosis; Early Intervention (Education); Education; Education, Continuing; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Health Personnel - education; Hospital Mortality; Hospital Rapid Response Team; Humans; Inpatients - statistics & numerical data; Intensive care medicine; Intensive Care Units - statistics & numerical data; Interdisciplinary Communication; Male; Medical Emergency Team; Medical sciences; Middle Aged; Nurses; Outcome; Physicians; Prospective Studies; Vital Signs
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2010.03.001

Abstract Aim To determine whether the introduction of a multi-faceted intervention (newly designed ward observation chart, a track and trigger system and an associated education program, COMPASS© ) to detect clinical deterioration in patients would decrease the rate of predefined adverse outcomes. Methods A prospective, controlled before-and-after intervention of trial was conducted in all consecutive adult patients admitted to four medical and surgical wards during a 4 month period, 1157 and 985, respectively. A sub-group of patients underwent vital sign and medical review analysis pre-intervention (427) and post-intervention (320). The outcome measures included: number of unplanned admissions to the intensive care unit (ICU), Medical Emergency Team (MET) reviews and unexpected hospital deaths, vital sign documentation frequency and incidence of a medical review following clinical deterioration. This study is registered, ACTRN12609000808246. Results Reductions were seen in unplanned admissions to ICU (21/1157 [1.8%] vs. 5/985 [0.5%], p = 0.006) and unexpected hospital deaths (11/1157 [1.0%] vs. 2/985 [0.2%], p = 0.03) during the intervention period. Medical reviews for patients with significant clinical instability (58/133 [43.6%] vs. 55/79 [69.6%] p < 0.001) and number of patients receiving a MET review increased (25/1157 [2.2%] vs. 38/985 [3.9%] p = 0.03) during the intervention period. Mean daily frequency of documentation of all vital signs increased during the intervention period (3.4 [SE 0.22] vs. 4.5 [SE 0.17], p = 0.001). Conclusion The introduction of a multi-faceted intervention to detect clinical deterioration may benefit patients through increased monitoring of vital signs and the triggering of a medical review following an episode of clinical instability.