Using an electronic health record to address findings of a post resuscitation committee in a community hospital

Purpose:
To evaluate how a post resuscitation committee and electronic health record (EHR) committee implemented interventions to cardiac or respiratory arrests through the use of EHR solutions, education and communication. To analyze the improved patient outcomes including use of a rapid response team.

Significance:
The Post Resuscitation committee led activities to improve patient outcomes. Teaming with the electronic health record committee provided more effective patient management and better training for rapid response team members. Using quantitative data, the two groups were able to track improvements.

Strategy and Implementation:
EHR solutions included insulin sliding scale order sets, hypoglycemia order sets and protocols, stroke order sets and code status order documentation. Decision support rules targeted code status alerts for physicians, flexible monitoring utilization and transfer decision awareness. Rapid response teams (RRTs) responded in a preemptive fashion to a change in clinical status (Condition C) to aid the bedside nurse in assisting patients before a crisis (Condition A) occurs. Education for the rapid response team members focused on “First Three Minutes” training, critical thinking workshops, code simulation, classroom mock codes and communication training incorporating SBAR (Situation, Background, Assessment Recommendation). Condition events were tracked, evaluated and analyzed. Quality data was tracked to guide intervention implementation and track patient outcomes.

Evaluation:
Total Condition A's have fallen since 2004 from 10 to under 5 per 1000 discharges. Significant outcomes include: mortality trending down since 2006, decreased intubations (from 2.5 to 1.5 per 1000 discharges), appropriate patient monitoring and decreased transfers to higher levels of care.

Implications for Practice:
A post resuscitation committee improved patient outcomes. Partnered with electronic health record staff, interventions prevented cardiac and respiratory arrests. Increased education and communication empowered rapid response teams to better assist bedside nurses, preventing medical crises.