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PSNet: Patient Safety Network
Journal Article

Clinical triggers: an alternative to a rapid response team.

Moldenhauer K, Sabel A, Chu ES, et al. Joint Commission journal on quality and patient safety. 2009;35:164-74.

A national campaign to save lives in the hospital setting initially catalyzed implementation of rapid response systems. Although past research led to controversy over their widespread adoption, the ability to identify at-risk patients and prevent them from clinically deteriorating remains important. This study developed a clinical triggers program that focused on systematic use of existing housestaff teams to respond to patients in distress. Rather than a dedicated and resource-intensive rapid response team, this hospital required nurses to trigger a call to the primary team based on specific physiologic parameters, and then required responding housestaff to complete a form following direct communication with the bedside nurse. The guidelines also required timely discussion with an attending physician, which ultimately led to a decrease in non-ICU cardiopulmonary arrests and ICU bounceback rates. While their model may apply only to similar teaching institutions, it does provide a unique prototype for addressing failure to rescue initiatives that leverage existing resources rather than creating new ones.