Paul Levy posts a report on a program at Beth Israel Deaconess Medical Center in which clinicians use a variety of "triggers" to take action that helps keep patients from dying or getting worse. Among the findings:

Always beware of unintended consequences: A program designed to let patients order food when and how they want it started causing problems for people who might swallow the food into their lungs (ditto for patients whose family members brought food in from outside).

Doctors really need to listen to nurses, especially when the nurses express "marked concern" about a patient's condition:

... When we implemented the Triggers program, many physicians were very nervous about giving this criterion. They were afraid that they might be called in the middle of the night for things that weren't really important, and that nurses might use this as a weapon if they did not like the physician or if they disagreed with the plan of care.

Well, it turns out that nurses use this Trigger quite judiciously – only 15% of our Triggers are called only for nursing concern. (In another 27% of cases, nurses express "marked concern" but the patient also meets other criteria simultaneously.) It also turns out that if nurse has "marked nursing concern," it means you're really sick. The in-hospital mortality rate for a patient who has a Trigger called for "marked nursing concern" is 10.7%.

This is roughly twice as bad as showing up to the Emergency Department with a heart attack. Literally.