An electronic alert system targeting adult patients in 3 hospital units (ward, telemetry, and transitional care unit) will be deployed at two KPNC hospitals (South San Francisco and Sacramento). The alert system provides early (12 hours) warning about a patient’s impending risk of deterioration as well as global risk around the time of admission to the hospital. It will be coupled with changes in clinician workflow (e.g., use of an automated checklist for patients who have triggered an alert) as well as frequent feedback on hospital adverse events from the DOR. To evaluate the pilot intervention, a difference in differences analysis will be conducted in which adverse outcome rates in the two pilot sites will be compared against the remaining 19 KPNC hospitals. Data from the pilot will be used to estimate duration of a stepped wedge cluster randomized trial involving all remaining KPNC hospitals.