Critically-ill medical patients arriving to an emergency department can be time consuming and resource intensive. Beth Israel Deaconess Medical Center (BIDMC) wanted to better serve these patients by providing them with diagnosis and treatment faster and more efficiently. Our faculty was tasked with the goal of developing a system that would decrease time of arrival to provider, to intervention, and to treatment for patients presenting with abnormal vital signs to the BIDMC ED.


We developed a “trigger” program that would quickly and effectively identify patients who need immediate assistance. The trigger program was implemented through the following steps:

  • Development of an ED-specific “triggers” protocol:
    • Heart Rate: < 40 or >130;
    • Systolic Blood Pressure: < 90;
    • Respiratory Rate: < 8 to > 30;
    • SaO2: < 90% on room air.
  • Testing a sample size of 2165 patient records for trigger qualification (71 qualified);
  • The 71 patient records identified for meeting triggers criteria were reviewed to find themedian times to physician evaluation, to treatment, and to antibiotic administration;
  • Defining a trigger team: attending physician, senior resident, resource nurse, primarynurse, and technician;
  • Designating a trigger room to ensure availability at all times;
  • Outlining the triggers processes and training staff.
Our trigger program significantly decreased the length of time associated with 3 main length-of-stay metrics and improved BIDMC’s ability to service patients by:
  • Cutting the average length of time to initial physician evaluation by 45%;
  • Cutting the average length of time to treatment by 60%;
  • Cutting the average time to antibiotics administration by 56%.