Trigger team activation in the emergency department at a tertiary university hospital

Abstract

INTRODUCTION The aim of this study was to describe the diversity in the incidence, diagnosis and prognosis of patients met by the trigger teams for trauma, STEMI, stroke and medical emergency patients (MEP). METHODS This was a single-centre, retrospective cohort study of all patients admitted to Odense University Hospital (OUH) from November 2012 to September 2015 with trauma, STEMI, stroke or MEP trigger team activation on arrival. OUH is a tertiary referral centre for patients with severe trauma, STEMI (directly referred to the catheterisation laboratory), stroke and MEP. RESULTS A total of 8,075 trigger team activations were recorded, a median of eight calls per day (range: 1-18), covering 16.7% trauma calls, 28.3% STEMI calls, 19.7% stroke calls and 35.3% MEP calls. This corresponds to 160/100,000 person years (py) trauma calls, 65/100,000 py STEMI calls, 73/100,000 py stroke calls and 339/100,000 py MEP calls. Seven-day mortality was 10% (95% confidence interval (CI): 9-12%) for patients with trauma calls, 6% (95% CI: 5-7%) for STEMI calls, 3% (95% CI: 3-4%) for stroke calls and 16% (95% CI: 15-17%) for MEP calls. Patients from trauma, STEMI and stroke calls were discharged with a diagnosis within 3-5 International Classification of Diseases (version 10) main coding areas, whereas patients from MEP calls had discharge diagnoses within 13 main coding areas. CONCLUSION Patients with MEP calls are more frequent, have a more diverse aetiology and a higher mortality than patients in the other trigger teams. A need exists for further guidelines and research regarding MEP with a view to reducing the high mortality rate among MEP in the future. FUNDING Annmarie Lassen was funded by an unrestricted grant from the philanthropic fund the Tryg Foundation given to the University of Southern Denmark. TRIAL REGISTRATION The study was approved by the Danish Health Authority (Record no. 3-3013-1385/1) and the Danish Data Protection Agency (Record no. 2013-41-2435).