Over a three-year period, the program prevented more than 4,000 deaths, outpacing a group of nearly 1,100 peer hospitals by 12%, according to findings recently published in The Joint Commission Journal on Quality and Patient Safety.
“This is an incredible achievement for Ascension,” Mohamed Fakih, MD, Ascension’s chief quality officer, said.
Becker’s recently spoke to Dr. Fakih to learn more about how the health system implemented Recognize and Rescue, what made it successful and how its structure can be applied to other quality initiatives.
A framework for saving lives
The impetus behind the Rescue and Recognize program dates to the COVID-19 pandemic, when large numbers of severely ill patients put strain on the healthcare workforce and mortality rates started to increase. In 2021, leaders determined the best path forward was to create a framework to help clinical teams proactively identify and manage high-risk conditions with greater consistency.
To achieve this, Ascension assembled a multidisciplinary team — including physicians, nurses, respiratory therapists, pharmacists and data analysts — to develop a tool kit with concrete actions to mitigate risk when managing high-risk patients. It was designed around two core components: recognize, which is focused on preventing deterioration through early identification of high-risk patients, and rescue, which centers on strengthening early intervention and escalation processes when a patient shows signs of decline.
This framework included a bundle of targeted interventions addressing sepsis, respiratory compromise, infection prevention and medication risk. In cases of respiratory decline, for instance, the bundle offers detailed guidance on when to escalate care and intervene.
“When do you take them to the intensive care unit? How do you ensure that they are getting the optimal treatment?” Dr. Fakih said.
While reducing mortality was the primary measure of success, Recognize and Rescue also led to measurable improvements in infection rates. Over the study period, Ascension saw a 25% drop in central line-associated blood stream infections and a 30% reduction in hospital-onset C. difficile infections. Acute kidney injury rates also fell 6%.
These improvements have been sustainable, with Ascension hospitals performing even better on these measures than at the end of the study period in 2023, Dr. Fakih said.
The impact of the Recognize & Rescue program has garnered national attention, with peers recognizing its potential to be replicated to enhance patient outcomes across health systems.
“While this study spanned 88 hospitals, that is but a small proportion of such acute care facilities that operate in the United States,” Brent James, MD, former chief quality officer at Salt Lake City-based Intermountain Healthcare, wrote in an editorial on Ascension’s initiative.
“These results are replicable. Every board of trustees that oversees any competent, ethical care delivery group should make this work a focus of careful study, reflection and action. The quality chasm is real. As Dr. Fakih’s work clearly demonstrates, it is possible to close that gap. Far better care is within our grasp.”
Dr. James, a clinical professor at Stanford (Calif.) University School of Medicine, was not involved in the research at Ascension.
Effective implementation
Leaders at Ascension credit the Recognize and Rescue initiative’s success to a well-crafted implementation process that created accountability and granted hospitals enough flexibility to focus on their biggest opportunities for improvement.
To instill accountability, Ascension established a meeting cadence in which stakeholders from 11 hospital markets convened once a month with system leaders to discuss review performance data, identify gaps and share best practices from high-performing hospitals. As the health system saw mortality rates begin to drop, these meetings were scaled back to once every two months.
“It wasn’t just about providing the bundle — it’s about all of these elements together,” Dr. Fakih said. “Making sure it’s implemented locally, providing feedback on performance, knowing where gaps are and making sure the accountability is there.”
Ascension is now leveraging the Recognize and Rescue framework to drive additional quality improvement efforts. It is exploring using the model to address diagnostic stewardship and specific safety goals, such as patient falls.
“We can use the same venue for other quality improvement initiatives, or initiatives to reduce clinical variation,” Dr. Fakih said.