Enhancement of Critical Care Response Teams

Personal Health Information Technology

Enhancement of Critical Care Response Teams through the use of electronic nursing-mediated vital signs surveillance

The objective of this project will be to demonstrate the use of vital sign capture and monitoring to enhance the effectiveness of the Ontario Critical Care Response Teams (CCRTs). This will be facilitated through the capture of vital sign data into an electronic format, applying rules and logic to this data to identify patient deterioration, and generating an automated alert to the appropriate clinician when deterioration is detected.


Ontario hospitals have implemented Critical Care Response Teams (CCRTs) that are dedicated to critical care management of ward-based patients. Currently, the calling criteria for CCRTs are based on vital sign parameters and recognition of deterioration through visual cues. The primary purpose of this technology will be to enhance the CCRT program by supporting more timely recognition of patient deterioration by front line care providers. We envision that busy clinicians coordinating multiple tasks will no longer rely solely on visual signs of deterioration (through information analysis or pattern recognition) to alert them when something is wrong. The automated alerting system will monitor a patient’s vital signs so that early trends of deterioration are detected before more severe variations in vital signs develop. When vital sign changes indicate deterioration, a notification will immediately alert the appropriate clinician that there may be a problem and/or a call to the CCRT may be required.

The team is currently working on the third phase of this project. In the first phase, a thorough analysis of the existing workflow revolving around vital sign documentation and the operations of the CCRTs was conducted by the Healthcare Human Factors team. Deriving from this workflow analysis, an electronic vital signs smartphone application was developed, and underwent high fidelity usability testing with clinical staff from UHN. Given the positive feedback achieved during the usability tests, the team proceeded with the second phase of the project where the application was developed further so as to include data transmission functionality, as it was integrated with Mount Sinai Hospital’s Electronic Health Record (EHR). A two-month trial of the vital signs capture system at MSH was conducted and found that the application was well received by the nursing staff in terms of its user-friendliness, though issues revolving around slow logins and the lack of multi-tasking capabilities did impact adoption to a degree. In our next phase of the trial, we aim to fully implement the system by activating the automatic alerting functionality, thereby directly engaging the CCRT staff and determining the effectiveness of the Early Warning Score (EWS) calling criteria that will be implemented. As a complement to this implementation work, a study will be conducted to assess the effectiveness of various EWS algorithms through an analysis of retrospective vital signs data provided by participating hospitals. Through this research and the associated technology development, we aim to improve the workflow around vital sign capture, and enhance the life-saving work of the CCRT program.

Funding Agency

Ontario Ministry of Long Term Care (MOHLTC)


Ontario Ministry of Long Term Care (MOHLTC)

Mt. Sinai Hospital

Project Team

David Chartash

Archana Gopal

Nathaniel Hamming

Jack Lam

Grant McInnes

Peter Picton

Kevin Tallevi

Mat Trudel

For more information about this project, contact:

Melanie Yeung