Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.
UNKNOWN
NA
6500 participants
INTERVENTIONAL
2018-05-18
2021-12-31
Brief Summary
Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.
A third of all acute medical patients with normal vital signs at arrival, experience a deterioration in vital signs during the 24 first hours. This can potentially lead to dire consequences for these patients, as the risk of deterioration is present across all severity levels. The utilization of patient monitoring systems in the dispersed and shared working environments of EDs and acute wards may help to identify some of the reasons for failure to rescue patients. Thus, quantifying the extent to which a patient is being monitored, may be an aid to bridge the current gap between usage of automated and manual monitoring as clinical work will continue to depend on tacit knowledge and intuition.
Several systems and protocols have been established to swiftly deal with identified deterioration. Most systems struggle with issues of clinical adherence and are difficult to assess on-the-fly, and in some cases nurses failed to notice abnormality in 43% of patients experiencing deterioration. Although the trajectories of patients' vital signs have been identified as more important than the initial scoring value, most of the widely used Track and Trigger systems lack a temporal aspect. Furthermore, a limited number of these Track and Trigger systems have been integrated into real time clinical decision support systems, which has not evolved much in the last decades.
The PDWS deals with these challenges by aggregating and summarizing all vital values measured with the ED's patient monitors in the ongoing admission to intuitively present the state and trajectory. The investigators intend to determine if making the PDWS system available to nurses and physicians throughout the entire ED improves their ability to identify patients at risk of deterioration. To make this assessment, the PDWS will be evaluated in a cluster randomized trial (CRT) at two ED facilities in Denmark. The CRT is structured in three 5-week intervention, and three 5-week control periods, separated by a washout period of at least one week. The primary outcome is in-hospital deterioration - defined as transfer to the intensive care unit, heart/respiratory failure or death. The effect the PDWS will be assessed by comparing the proportions of events in each study arm using Pearsons's chi-squared test on these two samples. Furthermore, the technical and economical effects are evaluated using the Technology Acceptance Model, and the Model for Assessment of Telemedicine.
Related Clinical Trials
Explore similar clinical trials based on study characteristics and research focus.
Development and Evaluation of a Patient Safety Model
NCT03457272
National Early Warning Score and D-dimer to Identify Medical Patients At Low Risk of 30-day Mortality
NCT03108807
Correlation Between Monitoring Frequency and Clinical Deterioration in Hospitalized Patients
NCT02180854
Degree-of-worry and Illness Perception in Patients Suffering From Acute Illness in the Emergency Department
NCT04226040
Identification of High-Risk Patients at Admission to an Emergency Department by Non-Invasive Hemodynamics
NCT03934775
Detailed Description
Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.
Conditions
See the medical conditions and disease areas that this research is targeting or investigating.
Study Design
Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.
NON_RANDOMIZED
PARALLEL
SUPPORTIVE_CARE
NONE
Study Groups
Review each arm or cohort in the study, along with the interventions and objectives associated with them.
Intervention arm
All vital signs registered as part of usual care are used for modelling patients state and trajectories and made available to clinicans via the Patient Deterioration Warning System in nursing and physician offices.
PDWS Intervension
Patients admitted to the emergency department in the intervention period will have their vital values presented on the PDWS in addition to existing patient monitoring systems
Control arm
Usual care
No interventions assigned to this group
Interventions
Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.
PDWS Intervension
Patients admitted to the emergency department in the intervention period will have their vital values presented on the PDWS in addition to existing patient monitoring systems
Eligibility Criteria
Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.
Inclusion Criteria
Exclusion Criteria
* Orthopedic patients with minor injuries
18 Years
ALL
No
Sponsors
Meet the organizations funding or collaborating on the study and learn about their roles.
Odense University Hospital
OTHER
Hospital of South Western Jutland
UNKNOWN
University of Southern Denmark
OTHER
Responsible Party
Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.
Thomas Schmidt
Assistant Professor
Locations
Explore where the study is taking place and check the recruitment status at each participating site.
Odense University Hospital
Odense, Fyn, Denmark
Hospital of South Western Jutland
Esbjerg, Jylland, Denmark
Countries
Review the countries where the study has at least one active or historical site.
References
Explore related publications, articles, or registry entries linked to this study.
Henriksen DP, Brabrand M, Lassen AT. Prognosis and risk factors for deterioration in patients admitted to a medical emergency department. PLoS One. 2014 Apr 9;9(4):e94649. doi: 10.1371/journal.pone.0094649. eCollection 2014.
Kellett J, Emmanuel A, Deane B. Who will be sicker in the morning? Changes in the Simple Clinical Score the day after admission and the subsequent outcomes of acutely ill unselected medical patients. Eur J Intern Med. 2011 Aug;22(4):375-81. doi: 10.1016/j.ejim.2011.03.005. Epub 2011 Apr 8.
Armstrong B, Walthall H, Clancy M, Mullee M, Simpson H. Recording of vital signs in a district general hospital emergency department. Emerg Med J. 2008 Dec;25(12):799-802. doi: 10.1136/emj.2007.052951.
Brier J, Carolyn M, Haverly M, Januario ME, Padula C, Tal A, Triosh H. Knowing 'something is not right' is beyond intuition: development of a clinical algorithm to enhance surveillance and assist nurses to organise and communicate clinical findings. J Clin Nurs. 2015 Mar;24(5-6):832-43. doi: 10.1111/jocn.12670. Epub 2014 Sep 19.
Brabrand M, Hallas J, Knudsen T. Nurses and physicians in a medical admission unit can accurately predict mortality of acutely admitted patients: a prospective cohort study. PLoS One. 2014 Jul 14;9(7):e101739. doi: 10.1371/journal.pone.0101739. eCollection 2014.
Schmidt T, Bech CN, Brabrand M, Wiil UK, Lassen A. Factors related to monitoring during admission of acute patients. J Clin Monit Comput. 2017 Jun;31(3):641-649. doi: 10.1007/s10877-016-9876-y. Epub 2016 Apr 12.
Acutely Ill Patients in Hospital: Recognition of and Response to Acute Illness in Adults in Hospital [Internet]. London: National Institute for Health and Clinical Excellence (NICE); 2007 Jul. Available from http://www.ncbi.nlm.nih.gov/books/NBK45947/
Clifton DA, Wong D, Clifton L, Wilson S, Way R, Pullinger R, Tarassenko L. A large-scale clinical validation of an integrated monitoring system in the emergency department. IEEE J Biomed Health Inform. 2013 Jul;17(4):835-42. doi: 10.1109/JBHI.2012.2234130.
Fuhrmann L, Lippert A, Perner A, Ostergaard D. Incidence, staff awareness and mortality of patients at risk on general wards. Resuscitation. 2008 Jun;77(3):325-30. doi: 10.1016/j.resuscitation.2008.01.009. Epub 2008 Mar 14.
Murray A, Kellett J, Huang W, Woodworth S, Wang F. Trajectories of the averaged abbreviated Vitalpac early warning score (AbEWS) and clinical course of 44,531 consecutive admissions hospitalized for acute medical illness. Resuscitation. 2014 Apr;85(4):544-8. doi: 10.1016/j.resuscitation.2013.12.015. Epub 2013 Dec 21.
Smith GB, Prytherch DR, Schmidt P, Featherstone PI, Knight D, Clements G, Mohammed MA. Hospital-wide physiological surveillance-a new approach to the early identification and management of the sick patient. Resuscitation. 2006 Oct;71(1):19-28. doi: 10.1016/j.resuscitation.2006.03.008. Epub 2006 Aug 30.
Gorges M, Staggers N. Evaluations of physiological monitoring displays: a systematic review. J Clin Monit Comput. 2008 Feb;22(1):45-66. doi: 10.1007/s10877-007-9106-8. Epub 2007 Dec 7.
Kidholm K, Ekeland AG, Jensen LK, Rasmussen J, Pedersen CD, Bowes A, Flottorp SA, Bech M. A model for assessment of telemedicine applications: mast. Int J Technol Assess Health Care. 2012 Jan;28(1):44-51. doi: 10.1017/S0266462311000638.
Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
PDWS
Identifier Type: -
Identifier Source: org_study_id
More Related Trials
Additional clinical trials that may be relevant based on similarity analysis.