Innovative Technology to Improve Response to Early Signs of Clinical Deterioration

Purpose:
Multifactoral issues contribute to failed recognition of early signs of deterioration on med/surg units. Innovative technology solutions were combined with an early warning system to improve: recognition and response to early deterioration, RN workflow, communication, and situational awareness.

Relevance/Significance:
Signs of early deterioration require recognition and intervention to prevent further compromise. Technological solutions can leverage risk stratification using an early warning system to help drive clinical intervention, provide operational tools to increase situational awareness, display aggregated clinical data to promote critical thinking and communication, capture increased acuity to ensure appropriate staffing, and collect discrete data for outcome and quality review.

Strategy and Implementation:
Using an iterative approach, clinical staff worked with IT analysts to develop novel ways to: 1) display aggregated clinical data to providers without logging into the EMR, 2) leverage real-time risk stratification using an early warning system (EWS) to drive clinical intervention, 3)provide nurses with operational tools to ensure EWS scores are acted on and to escalate score based on clinical assessment, 4) utilize smartform technology to organize data in one location, and 5) capture data discretely for outcome and quality review. Staff nurses were consulted throughout the development and testing phases to ensure IT tools enhanced their delivery of care. Education on the importance of accurate and timely vital sign measurement and documentation was provided to nursing assistance and RN training was scenario-based to demonstrate how the IT tools are to be used in combination with critical thinking to improve patient outcomes. This pilot began on all med/surg units Jan., 2015.

Evaluation:
Comparison of 2014 data to 2015 pilot data shows codes decreased by 33% and rapid responses increased by 53%. Patient time spent with “out of range” VS decreased by 35% post implementation. Additional data is being analyzed and qualitative research is in progress to determine RN perception of pilot on nursing practice with early results showing satisfaction and positive impact on practice.

Implications for Practice:
Early identification of signs of clinical deterioration improves patient assignment to appropriate level of care and supports staffing adjustment for changes in patient condition. IT tools to improve workflow, communication and situational awareness contribute to efforts to improve patient outcomes.