Track and trigger in an emergency department: an observational evaluation study

Area of Science:

• Emergency Medicine
• Clinical Monitoring
• Patient Safety

Background:

• Track and trigger (T&T) charts are used in UK emergency departments (EDs) to monitor patient vital signs.
• Effective utilisation of T&T charts is crucial for early recognition of patient deterioration.

Purpose of the Study:

• To evaluate the utilisation and accuracy of paper-based T&T charts in a UK ED.
• To assess the impact of T&T chart documentation on identifying patient escalations.

Main Methods:

• A prospective observational cohort study was conducted in a medium-sized teaching hospital's ED.
• Vital sign data and clinical notes were analysed to identify escalation events.
• T&T scores were calculated retrospectively for patient vital signs.

Main Results:

• Data from 472 patient episodes were analysed; 60.6% had a T&T score documented, but only 34.5% of observation sets had a corresponding score.
• 20.6% of T&T scores were incorrect, potentially hindering the recognition of patient deterioration.
• While only 26.9% of physiological escalations had a documented T&T score above the threshold, retrospective chart completion increased this to 94.2%.

Conclusions:

• Paper-based T&T charts in the ED face challenges with poor completion rates and calculation errors.
• Despite these issues, T&T charts hold potential for identifying deteriorating patients.
• Future research will explore electronic systems for automated T&T score calculation in EDs.