2.50
Hdl Handle:
http://hdl.handle.net/10755/306595
Category:
Abstract
Type:
Poster
Title:
Right Unit, Right Bed, Right Now!
Author(s):
Homan, Nancy K.
Lead Author STTI Affiliation:
Non-member
Author Details:
Nancy K. Homan, MSN, MBA, RN, APRN-BC, NHoman@ChristianaCare.org
Abstract:

Evidence-based Practice Abstract

Purpose: RRTs (Rapid Response Team activations) following ED (Emergency Department) to inpatient transfer are tracked at four hour and twenty four hour milestones. In addition, RRTs necessitating transfer to a higher level of acuity are monitored for both time marks. The purpose of this new program was to analyze causes for RRT after ED transfer and develop appropriate interventions to impact potential or actual clinical deterioration. ‘Right unit, right bed, right now!’ was designed and implemented as a quality assurance project.

Design: A literature search was performed to explore insights on deterioration identification and intervention. IHI’s (Institute for Healthcare Improvement) Early Warning System (EWS) value table was identified as a potentially significant surveillance tool. Most literature addressed the use of an Early Warning System for medical-surgical units. The concept was recognized as transferrable to the ED setting.

The EWS instrument was applied to patients in the ED upon receipt of an inpatient bed assignment. An elevated score prompted reexamination of assigned acuity level via ED clinician huddle.

Setting: A teaching, suburban, Level 1 Emergency Department with >118,000 visits per year.

Participants All patients admitted and assigned to a medical-surgical or stepdown unit.

Methods: IHI’s Early Warning System values were used to indicate risk of deterioration. Scores were color coded to highlight clinical threat, and tiered ED nurse responses were matched to elevated results.

Results/Outcomes: The EWS tool was well received by nursing staff, who felt that it was a mechanism of empowerment for patient advocacy, would prompt them to report deterioration to attending physicians, and would impact RRTs post ED transfer. The initial trial period brought no change in the number of RRT activations. However, ED to inpatient RRTs requiring transfer to a higher level of care decreased from facility baseline of 50% to 10%.

Implications: Use of an Early Warning System for early identification of deterioration has implications at many levels, including increasing patient safety by limiting unit to unit handoffs, improving family perception of hospital staff’s ability to provide safest care and enhancing RN satisfaction in response to being given an empowering mechanism for advocacy of safe outcomes. Under the aegis of the CMS (Center for Medicare and Medicaid Services) Value-Based Purchasing Program, the Early Warning System surveillance tool has the potential to prevent failure to rescue, resulting in a decreased length of stay with consequent diminished risk of contracting hospital acquired conditions, and effecting a decrease in the mortality risk associated with requiring a Rapid Response Activation.

Keywords:
Early Warning System to detect Deterioration
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleRight Unit, Right Bed, Right Now!en_GB
dc.contributor.authorHoman, Nancy K.en_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsNancy K. Homan, MSN, MBA, RN, APRN-BC, NHoman@ChristianaCare.orgen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306595-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: RRTs (Rapid Response Team activations) following ED (Emergency Department) to inpatient transfer are tracked at four hour and twenty four hour milestones. In addition, RRTs necessitating transfer to a higher level of acuity are monitored for both time marks. The purpose of this new program was to analyze causes for RRT after ED transfer and develop appropriate interventions to impact potential or actual clinical deterioration. ‘Right unit, right bed, right now!’ was designed and implemented as a quality assurance project.</p><p>Design: A literature search was performed to explore insights on deterioration identification and intervention. IHI’s (Institute for Healthcare Improvement) Early Warning System (EWS) value table was identified as a potentially significant surveillance tool. Most literature addressed the use of an Early Warning System for medical-surgical units. The concept was recognized as transferrable to the ED setting.</p><p>The EWS instrument was applied to patients in the ED upon receipt of an inpatient bed assignment. An elevated score prompted reexamination of assigned acuity level via ED clinician huddle.</p><p>Setting: A teaching, suburban, Level 1 Emergency Department with >118,000 visits per year.</p><p>Participants All patients admitted and assigned to a medical-surgical or stepdown unit.</p><p>Methods: IHI’s Early Warning System values were used to indicate risk of deterioration. Scores were color coded to highlight clinical threat, and tiered ED nurse responses were matched to elevated results.</p><p> Results/Outcomes: The EWS tool was well received by nursing staff, who felt that it was a mechanism of empowerment for patient advocacy, would prompt them to report deterioration to attending physicians, and would impact RRTs post ED transfer. The initial trial period brought no change in the number of RRT activations. However, ED to inpatient RRTs requiring transfer to a higher level of care decreased from facility baseline of 50% to 10%.</p><p>Implications: Use of an Early Warning System for early identification of deterioration has implications at many levels, including increasing patient safety by limiting unit to unit handoffs, improving family perception of hospital staff’s ability to provide safest care and enhancing RN satisfaction in response to being given an empowering mechanism for advocacy of safe outcomes. Under the aegis of the CMS (Center for Medicare and Medicaid Services) Value-Based Purchasing Program, the Early Warning System surveillance tool has the potential to prevent failure to rescue, resulting in a decreased length of stay with consequent diminished risk of contracting hospital acquired conditions, and effecting a decrease in the mortality risk associated with requiring a Rapid Response Activation.</p>en_GB
dc.subjectEarly Warning System to detect Deteriorationen_GB
dc.date.available2013-12-09T17:00:29Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:29Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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