• Jason Imperato, Tyler Mehegan, Daniel J Henning, John Patrick, Chase Bushey, Gary Setnik, and Leon D Sanchez.
• *Department of Medicine,Harvard Medical School,Boston,MA.
• Can J Emerg Med. 2017 Jul 1; 19 (4): 249255249-255.

BackgroundBecause abnormal vital signs indicate the potential for clinical deterioration, it is logical to make emergency physicians immediately aware of those patients who present with abnormal vital signs.ObjectivesTo determine if 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 had a measurable effect on inpatient hospital metrics.MethodsThe study design was a retrospective pre and post intervention study. The intervention was the implementation of an ED clinical "triggers" program. Abnormal vital sign criteria that warranted a trigger response included: heart rate 130 beats/minutes, respiratory rate 30 breaths/minute, systolic blood pressure <90 mm Hg, or oxygen saturation <90% on room air. The primary outcome investigated was the median days admitted with secondary outcomes of median days in special care unit, in-hospital 30-day mortality and proportion of patients who required an upgrade in inpatient care level.ResultsThere was no difference in median days admitted for inpatient care (3.8 v. 4.0 days, p=0.21) or median days spent in a special care unit (5.0 v. 5.6 days, p=0.42) between the groups. There was no difference in the percentage of in-hospital patient deaths (6.0% v. 5.6%, p=0.66) or frequency of upgrade in level of care within 24 hours (4.9% v. 4.0%, p=0.52).ConclusionsIn our study, the implementation of an ED clinical triggers program did not result in a significant change in measured inpatient outcomes.

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