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Richmond, Va.-based VCU Health recently identified its top-quality concern for the 2020 fiscal year as decreasing mortality within the health system, which means lowering the failure to rescue events.
The health system decided to launch an initiative to achieve their goal. Here, Senior Performance Improvement Analyst at VCU Health Sharon Bednar discusses the initiative and where she sees innovation headed in the future.
Sharon Bednar: Practice prior to the FTR effort was very much a passive process at VCU Medical Center, VCU Health’s downtown academic medical campus. The process included use of the modified Early Warning Score (mEWS) calculated and written in the electronic medical record. The mEWS was available to clinical staff for awareness, but no specific action plans were tied to the value. Further, the rapid response team had to proactively browse the mEWS dashboard to identify any patient with an elevated mEWS, at which time, they would scramble to provide an assessment at the bedside.
The project team worked with a biostatistician to review a year of code blue data that identified 79 percent of patients who had a code blue event outside of the ICU were not evaluated by the rapid response team in the 24 hours prior to the event. This brought awareness that the current process was not sufficient in identifying and intervening on patients who showed early signs of clinical decline prior to the cardiac arrest. In effect, we ‘failed to rescue’ these patients. This is the point at which the team focused improvement efforts.
The new ‘Real-time Electronic Surveillance for Critical Care Unplanned Evaluations’ Alert is a data-driven process designed from a year of code blue data and a cross-sectional sample. The project team created a push notification to alert teams of patients demonstrating early signs of clinical decline. The EMR would automatically send a page to clinical team members when trigger parameters were met, decreasing the burden on team members needing to attend to the patient.