Intervening “pre-code”: “Howell hopes the team will prevent delays like one he described to the Beth Israel Deaconess board of directors last month: Doctors admitted an elderly man to the hospital for gastric bleeding. When his systolic blood pressure dipped into the 80s, his nurse and an intern gave him intravenous fluids to push it back up to normal range. His pressure climbed back into normal range. Over the next eight hours, the patient’s blood pressure kept falling, and they kept pumping in fluids. Low blood pressure is generally not life threatening until it dips into the 70s or 60s. But they failed to recognize that the subtler decline masked a more serious underlying problem: massive stomach bleeding. The next morning, a senior doctor did, and transferred the patient to the ICU, which has the staffing expertise and equipment to intervene more rapidly. But it was too late . . .

. . . Now, when a patient’s condition worsens in one of six specific ways, including systolic blood pressure that dips below 90, or when a nurse has marked concern about a patient, the nurse is required to set into motion a series of events called a trigger. The nurse pages a special team — including a senior nurse, an intern (a first-year doctor), and a respiratory therapist if it’s a breathing problem — immediately to the patient’s bedside. The intern is required to notify the resident, who is required to call the attending doctor, or senior physician.”

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