Early Warning System

Study Overview
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Brief Summary
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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
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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: 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. 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. 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. 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).

Official Title
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Comparing an Early Warning Alert With a Standardized Triage Intervention to Standard Care for the Management of Hospitalized Patients on General Hospital Wards.

Conditions
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Obstructive Sleep Apnea, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Cancer, Diabetes Mellitus

Intervention / Treatment
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* Other: Early warning system monitoring.
* Other: routine care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients hospitalized on the General Hospitals Wards of Barnes-Jewish Hospital. Exclusion Criteria: Patients with a do-not-resuscitate order, Patients not expected to survive their hospitalization.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Routine care<br>General hospital ward patients will receive routine care. | Other: routine care<br> <br> |
| Experimental: Intervention arm<br>The intervention with early warning system monitoring is to have the rapid response team assess the patients real-time. | Other: Early warning system monitoring.<br>* General hospital ward patients will be monitored 24/7 for clinical deterioration using the early warning system monitoring developed at Washington University.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ICU Transfer | Patients transferred to the ICU from a general hospital ward will be assessed as having met the outcome. | Patients will be assessed for the primary outcome measure during their hospital with an average of 14 days. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality | Death during hospitalization will be used to determine the presence of this outcome. | Patients will be asessed for the secondary outcome measure during an average of 28 days.. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Outcomes, Early warning systems, ICU transfer