How Southern New Hampshire Medical Center is cutting ICU admissions

When a New Hampshire hospital put a new communication bundle using rapid response calls into action, the hospital's rate of unplanned transfers to the intensive care and overall ICU admissions significantly declined, according to a pilot study published in the American Journal of Critical Care.

The pilot study examined the development and implementation of a communication bundle at Nashua-based Southern New Hampshire Medical Center. The 189-bed hospital placed a seven-item early-warning score system, which determine the degree of a patient's illness, into patients' EMRs in its four medical-surgical units and ICU.

The system's possible scores ranged from 0 to 21. Scores over 4 automatically triggered a red exclamation point next to the patient's name on the EMR, which the nurse and unit secretary could see.

As part of the communication bundle, the score alerted a critical care nurse assigned to respond to rapid response team calls. The ICU nurse then reviewed the patient's EMR and discussed the score with the patient's nurse to develop a care plan by phone.

ICU admissions after rapid response team calls and ICU admissions of patients with early-warning scores higher than 4 declined significantly during the study period, which suggests patients with deteriorating conditions were able to be identified sooner.

The findings also suggest the communication bundle led to a considerable decrease in staff response time to early-warning score alerts on patients' EMRs.

"The early-warning score helps identify patients with clinical signs of deterioration, but that information must be quickly communicated to a nurse with an appreciation for the urgency of the situation and the knowledge to take action," said primary investigator Cheryl Gagne, RN, DNP, the hospital's chief nursing officer. "Our communication bundle may have led to earlier and more effective interventions by medical-surgical nurses, facilitated by collaboration with experienced critical care nurses."

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