Emerg Med J 30:186-191 doi:10.1136/emermed-2011-200499
  • Original article

Track and trigger in an emergency department: an observational evaluation study

  1. Lionel Tarassenko3
  1. 1Emergency Department, Oxford University Hospitals NHS Trust, Oxford, UK
  2. 2Emergency Department, Heatherwood and Wexham Park Hospitals NHS Foundation Trust, Berkshire, UK
  3. 3Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
  4. 4Department of Primary Health Care, University of Oxford, Oxford, UK
  1. Correspondence to Dr Sarah J Wilson, Emergency Department Secretary, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK; sarah.wilson{at}
  1. Contributors RP, RW, SJW and LT contributed to the ethics committee application and study design. SJW, RW and RP were involved in data collection, data entry, data analysis and results interpretation. DW, SF, DC and LT were involved in data analysis and results interpretation. SJW and DW prepared the manuscript. All authors have read and approved the content of the manuscript to be published.

  • Accepted 19 February 2012
  • Published Online First 22 March 2012


Objective To evaluate the utilisation of paper-based track and trigger (T&T) charts in a UK emergency department (ED).

Methods A single-centre prospective observational cohort study was conducted in the ED of a medium-sized teaching hospital. Charted vital-sign data were collected from adults attending the resuscitation room, majors or observation ward. These data were examined in parallel with clinical notes to identify ‘escalation’ events. For each set of vital signs, the authors calculated the T&T score retrospectively.

Results Data from 472 patient episodes (2965 sets of vital signs) were examined. 85.8% of patients had at least one full set of observations (CEM standard) and 60.6% had at least one T&T score documented. However, only 34.5% of observation sets had a corresponding T&T score. 20.6% of T&T score totals (1024) were incorrect, potentially preventing a ‘trigger’ from being recognised. 204 patient episodes had at least one recorded escalation. Physiological escalations were associated with vital-sign scores that met the triggering thresholds (98/104), while patients who had non-physiological escalations or no escalations were more likely to have scores below the triggering thresholds (88/100). Only 26.9% of physiological escalations were associated with a documented T&T score above the triggering threshold. Retrospective completion of the charts increased that figure to 94.2%.

Conclusion T&T in the ED is challenged by poor completion rates and numerical errors made during score calculation. However the potential for recognition of a deteriorating patient should not be ignored. The future work of the authors intends to evaluate an electronic system for automatically calculating T&T scores within the ED environment.


  • Funding The work described in this paper has been funded by the National Institute for Health Research Biomedical Research Centre, Oxford. The funder played no part in the design of the study or in the analysis of the results.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the UK National Research Ethics Service (NRES), reference number 08/H1307/56.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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