PCT-led early warning vital sign escalation

Slow clinical escalation is an established source of patient deterioration, but there is limited literature investigating the structure of escalation on the basis of granular, timestamp-based information. To clarify the relevance of the workflow led by Patient Care Technician (PCT) and decide the effectiveness of the new system, it is crucial to comprehend whether the delay of escalation affects the following undesirable occurrences or not.

The purpose of this study was to measure the delay of escalation, to compare the patterns of the pre and post intervention and to test which delay increases were the ones linked with the bad proxies of the events (abnormal vital-sign episode and next-event occurrence). The objectives were as follows (1) to estimate changes in the median delay of escalation pre/post, (2) to describe abnormal rate of episodes time-varying, and (3) to model the relationship between.

The retrospective observational design was identified based on publicly available vital-data of the vital-sensations with timestamps. To simulate an intervention, a simulated pre/ post cut-point was held. Statistical analyses involved descriptive statistics, delay and abnormal-episode frequency run charts, independent-samples t-tests and logistic regression with odds ratios are adjusted.

Intermediate acceleration delay was reduced substantially after the intervention (pre-mean 4685 hours vs post-mean 407 hours t = 9.78 p =.001). There was no significant correlation between the delay to escalation and adverse events, and adjusted odds ratios were close to 1.00 and had very large confidence intervals, indicating sparseness of the data and quasi-separation. There was variation in abnormal episodes but no apparent improvement of the same after the intervention.

Results show that the duration of delay at escalation did not significantly predict poor outcomes in this data, though it was shorter after cut. Findings indicate the data limits and not clinical neutrality. To practice, the escalation processes of PCT-led workflows must maintain a dynamic mode, proper SOP reinforcing with its monitoring in real-time, and specific training. In future studies, the lack of richer, clinically contextual data and larger multi-unit QI assessments are needed to measure actual impacts.