Richmond, Va.-based VCU Health recently identified its top quality concern for the 2020 fiscal year as decreasing mortality within the health system, which means lowering the failure to rescue events.
The health system decided to launch an initiative to achieve their goal. Here, Senior Performance Improvement Analyst at VCU Health Sharon Bednar discusses the initiative and where she sees innovation headed in the future.
Question: What were the initial changes you made to lower the failure to rescue events? How did technology help?
Sharon Bednar: Practice prior to the FTR effort was very much a passive process at VCU Medical Center, VCU Health’s downtown academic medical campus. The process included use of the modified Early Warning Score (mEWS) calculated and written in the electronic medical record. The mEWS was available to clinical staff for awareness, but no specific action plans were tied to the value. Further, the rapid response team had to proactively browse the mEWS dashboard to identify any patient with an elevated mEWS, at which time, they would scramble to provide an assessment at the bedside.
The project team worked with a biostatistician to review a year of code blue data that identified 79 percent of patients who had a code blue event outside of the ICU were not evaluated by the rapid response team in the 24 hours prior to the event. This brought awareness that the current process was not sufficient in identifying and intervening on patients who showed early signs of clinical decline prior to the cardiac arrest. In effect, we ‘failed to rescue’ these patients. This is the point at which the team focused improvement efforts.
The new ‘Real-time Electronic Surveillance for Critical Care Unplanned Evaluations’ Alert is a data-driven process designed from a year of code blue data and a cross-sectional sample. The project team created a push notification to alert teams of patients demonstrating early signs of clinical decline. The EMR would automatically send a page to clinical team members when trigger parameters were met, decreasing the burden on team members needing to attend to the patient.
Q: How is the alert applied?
SB: The alert is designed for adult inpatient population outside of the ICU. The team identified a workflow risk in that when a patient was taken to a procedural area, the EMR was not aware of the patient location. This resulted in the rapid response team and other clinical providers responding to inpatient locations for an alert when the patient was actually in another location, such as procedural areas.
Having worked with the TeleTracking administrator on other projects I suggested that TeleTracking be used to interface and alert teams to the actual patient location. The clinical leaders did not know how this interface could support the RESCUE Alert. They did identify that this has been a longstanding issue for other alerts currently in place, namely the sepsis alert. If there was a solution, it would potentially be a solution for many alerts, not just RESCUE Alert. As the project manager for the RESCUE Alert, I requested a meeting with IT team members and TT administrator to see if there was a way to utilize both systems to accurately identify the patients’ actual location and make that part of the system page to the clinical teams. Clinical workflow would then be adjusted to this new information.
Q: What was the process of implementing the new technology?
SB: I met once with both teams and stepped out of their way to let them identify a possible solution. Together, they identified a pathway for success. Hospital leadership recognized this as a priority and resourced the request. TeleTracking and IT continue building an interface that is on target to move to testing by the end of September 2019.
The team is beyond excited for this new functionality. It will ultimately help teams triage patients in greatest need of critical care skillset and allow teams to respond to the patient’s actual location in a timely manner. During an emergency, time is critical, and therefore so is this initiative.
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