Evidence map›Paper›PMID 32948171›Full record

Observational studyBMC health services research2020

Type of Track and Trigger system and incidence of in-hospital cardiac arrest: an observational registry-based study.

Helen Hogan, Andrew Hutchings, Jerome Wulff, Catherine Carver, Elizabeth Holdsworth, Jerry Nolan, John Welch, David Harrison, Nick Black

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
  3. Article
  4. Article
  5. Article
  6. Review
  7. Review
  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Helen HoganDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Room 117, 15-17 Tavistock Place, London, WC1H 9SH, UK. helen.hogan@lshtm.ac.uk.ORCID http://orcid.org/0000-0002-0920-2093
Andrew HutchingsDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Room 117, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Jerome WulffIntensive Care National Audit and Research Centre, Napier House, 24 High Holborn, London, WC1V 6AZ, UK.
Catherine CarverDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Room 117, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Elizabeth HoldsworthDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Room 117, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Jerry NolanRoyal United Hospital Bath NHS Trust, Combe Park, Bath, BA1 3NG, UK.
John WelchCritical Care Outreach, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, Fitzrovia, London, NW1 2BU, UK.
David HarrisonIntensive Care National Audit and Research Centre, Napier House, 24 High Holborn, London, WC1V 6AZ, UK.
Nick BlackDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Room 117, 15-17 Tavistock Place, London, WC1H 9SH, UK.

Funding

National Institute for Health Research 12/178/18
6 · The paper itself

Abstract

backgroundFailure to recognise and respond to patient deterioration on hospital wards is a common cause of healthcare-related harm. If patients are not rescued and suffer a cardiac arrest as a result then only around 15% will survive. Track and Trigger systems have been introduced into the NHS to improve both identification and response to such patients. This study examines the association between the type of Track & Trigger System (TTS) (National Early Warning Score (NEWS) versus non-NEWS) and the mode of TTS (paper TTS versus electronic TTS) and incidence of in-hospital ward-based cardiac arrests (IHCA) attended by a resuscitation team.

methodsTTS type and mode was retrospectively collected at hospital level from 106 NHS acute hospitals in England between 2009 to 2015 via an organisational survey. Poisson regression and logistic regression models, adjusted for case-mix, temporal trends and seasonality were used to determine the association between TTS and hospital-level ward-based IHCA and survival rates.

resultsThe NEWS was introduced in England in 2012 and by 2015, three-fifths of hospitals had adopted it. One fifth of hospitals had instituted an electronic TTS by 2015. Between 2009 and 2015 the incidence of IHCA fell. Introduction or use of NEWS in a hospital was associated with a reduction of 9.4% in the rate of ward-based IHCA compared to non-NEWS systems (incidence rate ratio 0.906, p < 0.001). The use of an electronic TTS was also associated with a reduction of 9.8% in the rate of IHCA compared with paper-based TTS (incidence rate ratio 0.902, p = 0.009). There was no change in hospital survival.

conclusionsThe introduction of standardised TTS and electronic TTS have the potential to reduce ward-based IHCA. This is likely to be via a range of mechanisms from early intervention to institution of treatment limits. The lack of association with survival may reflect the complexity of response to triggering of the afferent arm of the rapid response system.

Indexed as

Clinical DeteriorationEarly Warning ScoreAgedAged, 80 and overEnglandFemaleHeart ArrestHospitalsHumansIncidenceLogistic ModelsMaleRegistriesRetrospective StudiesSurvival RateDeteriorationElectronic Track and Trigger systemIn-hospital cardiac arrestNational Early Warning ScoreTrack and Trigger system

Identifiers

PMID32948171
PMCPMC7501601

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.