The use of a track and trigger system on general medical wards

Introduction

Many groups have advocated identification of critically ill medical patients by abnormal or deteriorating physiological parameters. In Southend Hospital a track and trigger system has been used since 2005 to alert nurses to abnormal physiological parameters in order to trigger urgent medical review of the unwell patient. It is recognised that the respiratory rate is a particularly useful predictor of significant deterioration and should be measured with every set of observations. This audit aimed to assess the use of the track and trigger system on the medical wards and ensure that deteriorating critically ill patients are promptly reviewed.

Methods

Patient observation charts were reviewed for a specified 24-hour period. Data were gathered on the frequency and type of observations taken. For patients who met criteria to trigger a review, further data were abstracted about the nature of the deterioration and the promptness of the review.

Results

One hundred and sixty patient-days of observations were evaluated over seven medical wards. Twenty-nine patients met the trigger criteria and in 16 cases this represented a deterioration. Doctors were called in two cases. Observations were recorded with different frequency on different wards. One ward managed to record the respiratory rate with every set of observations.

Conclusion

Documented deteriorations in physiological observations did not trigger medical review. This may be a communication failure or failure to recognise recorded observations as abnormal. For this process to work well relevant observations must be recorded regularly and accurately. The respiratory rate was not consistently recorded between wards and the frequency of measurement of observations was variable. Further education and training is needed to improve recording of the respiratory rate and work needs to be done to establish why doctors were not called appropriately. Concerns about the volume of work generated by the system are unfounded. A positive predictive value of 55% is acceptable and 29 'triggers' in a 24-hour period are manageable.