Advance Alert Monitor

Problem: The acute deterioration of patients outside the Intensive Care Unit (ICU) are safety and quality concerns. Studies have shown that these deteriorations are associated with increased morbidity and mortality. This study aims to standardize the Rapid Response Team (RRT) nurse documentation in response to an Advanced Alert Monitor (AAM) alert, as at baseline no such alert nor standardized response and documentation exist. Context: Hospitals are continually challenged to innovate and create systems that can track multiple parameters and identify at-risk patients earlier on. An Early Warning System (EWS) in combination with a RRT significantly reduces patients’ potential for clinical decline. Predictive analytic systems such as an EWS are being introduced in response to this challenge and are anticipated to become the standard of care. The healthcare system/organization examined in this study aims to provide high quality, affordable health care services; and to improve the health of its members and the communities it serves. The Advance Alert Monitor (AAM) program enables this healthcare system/organization to better deliver on that mission by closing the quality gap of failure to recognize clinical decline in patients’ conditions. Interventions: The health system’s EWS is the AAM program. Its goal is to address safety and quality concerns associated with failing to identify a decline in patients’ conditions in a timely manner. The electronic health record and other sources are scanned constantly to generate an AAM score hour. If the score is eight percent or greater risk of deteriorating within 12 hours, E-Hospital staff review the patient’s chart and notify the RRT nurse. The RRT nurse collaborates with the primary nurse to assess the patient and communicate findings to the attending hospitalist. A standardized RRT nursing note is utilized to document the response for all initial AAM alerts. Measures: A family of measures was developed for the project. The outcome measure focused on the percentage of RRT nursing notes present for all initial AAM alerts. This measure recorded both a response and documentation of that response to the alert. Process measures included RRT proactive rounding documentation, and training of 100% RRT nurses on the AAM workflow. Tracking of code blue events outside the ICU was used as a balancing measure. Results: From January 1through June 30, 2018, there were 527 initial AAM alerts. Of those, 504 (95.6%) initial AAM alerts had the RRT nursing note present which indicates an intervention was made. Conclusions: The aim of this project was to integrate AAM predictive analytics with RRT practices that include a newly implemented standardized RRT nursing note; with AAM enabling early intervention to prevent a decline in patients’ conditions, and the RRT nursing note the documentation of such. The project was successfully implemented at the medical center with 95.6% RRT nursing note completion - and thus an intervention made - for all initial AAM alerts