Early Warning System
Condition: Congestive Heart Failure; Chronic Obstructive Pulmonary Disease; Cancer; Diabetes Mellitus; Obstructive Sleep Apnea
MeSH terms: Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Sleep Apnea, Obstructive; Heart Failure
Study type: Interventional

Summary: 
      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:
    

Detailed description: 
      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).
    

Intervention name(s): Early warning system monitoring.; routine care
Intervention type(s): Other; Other
Intervention description(s): General hospital ward patients will be monitored 24/7 for clinical deterioration using the early warning system monitoring developed at Washington University.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Outcomes; Early warning systems; ICU transfer