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General hospital ward patients will receive routine care.

The intervention with early warning system monitoring is to have the rapid response team assess the patients real-time.

General hospital ward patients will be monitored 24/7 for clinical deterioration using the early warning system monitoring developed at Washington University.

Early warning system monitoring.

routine care

Marin Kollef, MD

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:

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).

Early Warning System

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

Patients transferred to the ICU from a general hospital ward will be assessed as having met the outcome.

Death during hospitalization will be used to determine the presence of this outcome.

The Foundation for Barnes-Jewish Hospital

American College of Chest Physicians

Washington University School of Medicine

General hospital ward patients will receive routine care.

routine care =286

Routine Care

Patients will have active surveillance by the early warning system performed on a real-time basis to identify clinical deterioration.

Early warning system monitoring.: General hospital ward patients will be monitored 24/7 for clinical deterioration using the early warning system developed at Washington University. = 285

Intervention Arm

General hospital ward patients will receive routine care.

routine care

Patients will have active surveillance by the early warning system performed on a real-time basis to identify clinical deterioration.

Early warning system monitoring.: General hospital ward patients will be monitored 24/7 for clinical deterioration using the early warning system developed at Washington University.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Early Warning System	NCT01741480	Congestive Hear... Chronic Obstruc... Cancer Diabetes Mellit... Obstructive Sle...	Early warning s... routine care	18 Years - 100 Years	Washington University School of Medicine
Early Warning System	NCT01741480	Congestive Hear... Chronic Obstruc... Cancer Diabetes Mellit... Obstructive Sle...	Early warning s... routine care	18 Years - 100 Years	Washington University School of Medicine

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