How one California hospital improved care delivery without burdening staff

Just as consumers rely on their mobile devices to get breaking news and extreme weather alerts, healthcare providers often rely on mobile devices to receive urgent notifications regarding patients.

Though hospitals and health systems attempt to keep their clinicians connected through mobile devices, there are still communication mishaps. A common opportunity for such a mishap is when the emergency department receives an alert that a critical patient is coming in via ambulance. When the call comes in from the emergency medical responders, the hospital starts to assemble their team to respond.

The fast paced, dynamic state of the ED means it can be difficult to track down all the members of a response team. Multiple calls may be required, and there may be delays based on what is going on elsewhere in the department. These issues can lead to delays in patient care delivery—and these patients can’t afford those delays.

Sutter Roseville (Calif.) Medical Center is a 328-bed, community hospital with STEMI center, Primary Stroke Center, ACS level II trauma center designations. More than 80,000 patients are seen in their ED each year.

In 2016, Sutter Roseville activated a monthly average of 79 trauma alerts, 42 stroke alerts, and 11 STEMI alerts. These alerts, however, did not represent all of their critical patients, who didn’t receive such focused care.

During a Feb. 27 webinar presented by Becker's Hospital Review and sponsored by Everbridge, Andrea Perry, MSN, RN, the ED Clinical Nurse Leader at Sutter Roseville Medical Center, detailed how the hospital improved care delivery for critical patients by utilizing an enhanced communication system to expedite team activation.

Development phase

The first step in developing a new process was identifying the issues. Nurses and providers alike were dissatisfied with resource allotment for critical patients not meeting alert criteria. They needed a new alert to activate a team response for patients presenting with cardiac arrest, altered mental status, and severe respiratory distress, among others.

To develop the alert, Sutter Roseville Medical Center brought together a multidisciplinary team of nurses, physicians, technicians, phlebotomy clinicians, radiology staff and more. The team experimented with patient care locations and responses. Between September 2016 and April 2017, leadership met with stakeholders to ensure resource allocation was amenable, reviewed studies to support process development and communicated with Everbridge on the overall alert design.

"Number one, we were taking care of our sickest patients everywhere," Ms. Perry said. "A lot of emergency departments have treatment zones set up. We had a place where our trauma patients would go, but other than that we pretty much took care of patients wherever a bed was open. Doing that really diluted our nurses' skill mix. They might not take care of a stroke alert for eight months or administer tPA for two years. So, one of the things we really wanted to do was create a zone where these alerts would go, so that we could have more consistent staffing and help our nurses grow their skills."

"We also decided we wanted to have some sort of critical medical activation," she continued. "Instead of having to call the doctor and imaging and the nursing supervisor, we wanted to activate the whole team too, so we could be ready to care for the patient rather than make all these phone calls."

Sutter Roseville Medical Center also identified opportunities for improvement in their Stroke Alert process. ED and Stroke Team leadership worked with bedside staff to identify barriers to timely care. Between September 2018 and May 2019, nursing "stroke champions" worked to support ED staff and ancillary departments through the new alert process. These champions were crucial in getting staff buy-in.

Results

Hospital staff compared various data points prior to and post critical alert implementation. Sutter Roseville Medical Center evaluated time between door to lab collection, door to intensive care unit admission and door to intubation, among other indicators.

Across the board the alert system helped reduce intervention times. Data from Sutter Roseville Medical Center demonstrated that patients’ door to medical screening time decreased by 62 percent, door to lab collection improved by 76 percent and door to intubation even decreased by 59 percent. This improved care delivery also led to a decreased door to inpatient admission time, improving it by 19 percent.

Improvements were also made in the delivery of care to acute stroke patients. Median door to tPA administration decreased by 25 percent. They achieved door to tPA within 45 minutes in 51 percent of cases, an increase of 16 percent from 2018 to 2019. Additionally, clinicians were able to increase the number of cases treated within 60 minutes to 76 percent in 2019, representing a 19 percent improvement.

Conclusion

Today, Sutter Roseville Medical Center estimates that it activates more than 120 code critical alerts per month, representing 33% of their critical medical activations. By having the alert system in place, clinicians are better equipped to rapidly prioritize and stabilize critically ill patients—resulting in both improved care delivery and staff satisfaction.

To learn about Everbridge, click here.

To view the webinar, click here

More articles on patient flow:

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New York hospital shuts down ORs after state inspection
Health systems tap surge tents to screen, treat COVID-19 patients

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