Early Intervention to Impact Outcomes: Implementing the Role of the “Crisis Nurse” as a Quality and Safety Initiative

Purpose:
The need to prevent patient deterioration and reduce the per capita cost of healthcare, led an academic quaternary care center to implement a proactive patient management role: Crisis Nurse to improve care delivery, optimize patient outcomes and enhance collaboration with the interdisciplinary team.

Relevance/Significance:
The challenges in health care are complex and seemingly overwhelming. Challenges range from the impacts of Health Care Reform, an aging population and multi-generational nursing workforce and the stress of how to efficiently leverage staffing resources to decrease expenses while optimizing patient outcomes. Likewise, increasingly complex patient care needs, clinical therapeutics, and interprofessional teamwork require sophisticated nursing judgment and innovation.

Strategy and Implementation:
The role of the Crisis Nurse is filled by highly skilled Baccalaureate prepared nurses with competence in critical care and was designed to flexibly integrate clinically across all adult inpatient levels of care: critical care, intermediate, and adult medical/surgical units 24/7. The role supplements the support of the clinical nurse to optimize outcomes and ensure clinical efficiency. On the off-shift this resource role is leveraged by the House Manager to support Adult Rapid Responses, Adult Code Blue and other clinical scenarios that require high-level support. Operationally these nurses are accountable to proactively round to evaluate the clinical condition of patients respond to Adult Rapid Response requests, Adult Code Blue, and hospital alerts including Stroke, Heart, and Sepsis. Their primary responsibility is for assessing the situation, collaborating with the response team, and to identify appropriate personnel for disposition of patient and document care provided.

Evaluation:
Preliminary outcomes include: •Reduction in overall LOS •Reduction in Overtime on Nursing units •Reduction in Incidental work time (late outs) •Reduction in transfer delays with change in patient status •Reduction in ED holds •Reduction in increased level of care transfers •Reduction in observed inpatient Code Blue

Implications for Practice:
These nurses continuously monitor patient outcomes against established standards, educate clinical nurses to promote early identification and intervention on deteriorating patients and support clinical research to improve patient care delivery.