1 / 41

Dawn to Dusk

Dawn to Dusk. Rapid Response UK 111. Team members. Patricia Burkhart, RN, PhD Associate Dean for Undergrad Studies, CON Cletus Carvalho , MD Med. Dir. of Inpatient Psychiatry, Psychiatry Residency Program Dir Rachel Copeland Associate Director of Finance, COM Dan Goulson, MD

devaki
Download Presentation

Dawn to Dusk

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dawn to Dusk Rapid Response UK 111

  2. Team members • Patricia Burkhart, RN, PhD • Associate Dean for Undergrad Studies, CON • Cletus Carvalho, MD • Med. Dir. of Inpatient Psychiatry, Psychiatry Residency Program Dir • Rachel Copeland • Associate Director of Finance, COM • Dan Goulson, MD • Medical Director, CAS • Kathy Isaacs, RN • Patient Care Manager, NICU • Paula Sandford • Business Officer, College of Dentistry

  3. original Project Charge Optimize coverage after normal hours within UK HealthCare

  4. “We must demonstrate outstanding outcomes. This will require a committed multi-disciplinary team approach that focuses aggressively on quality and efficiency. Standardization, coordination, and integration will be our core operating principals moving forward.” Michael Karpf, MD September 8, 2010

  5. Background • Sub-par performance in regards to mortality, quality, and safety • Night coverage has been identified as a system weakness • There have been some undesirable outcomes

  6. Issues • Personnel attending to deteriorating patients may not have the appropriate skills to intervene • Sometimes there is delayed activation of a rapid response to a deterioration

  7. The right skills to help the patient at the right time

  8. Research

  9. Night Coverage Task Force • An internal team sponsored by Dr. Lofgren • Led by Colleen Swartz and Dr. DePriest • Membership consists of high level medical, nursing, and administrative leaders

  10. Night Coverage Task Force • Made a preliminary report this past summer

  11. Literature Review

  12. Hospitalists would solve issues Improve-ments included RRT Weinstein, 2002 Schulkin, 2008

  13. 24/7 coverage by intensivists Most had identifiable deteriora-tion before arrest Arabi, 2008 Schein, 1990

  14. Automated triggers increase RRT calls MEWS leads to earlier transfer to ICU Whittington, 2007 Stenhouse, 2000

  15. 51 cardiac arrests were prevented Lighthall, 2010

  16. Current State at Night • No services have attending in-house • Exceptions are ED, OB, and Anes • Much cross-covering exists among house staff • Nursing staff is relatively junior

  17. External Survey • Sent questions to top 7 performers in UHC • Asked about their models of care

  18. Highlights of findings • Clarian – Methodist • For deterioration, RRT is called first, then attending • RRT activated through a specific phone # • University Hospitals – Case • There is 24/7 medical hospitalist coverage both with and without NPs

  19. Highlights of findings • Ohio State • RRT includes hospitalist and acute care NP 24/7 • No response from Kansas, Arizona, Rush, or Wisconsin

  20. Interventions

  21. Several scenarios … Cost Intensivist + Hospitalist Procedural-trained Hospitalist + APP House staff & fellows Versatility

  22. Recommendations

  23. Three Prong Model • Rapid Response Team, 24/7 • Increase skill set at bedside and in RRT • Hospitalist for night coverage, 11p – 7a

  24. Rapid Response Team • Available constantly • Includes APPs • One consistent method of activation

  25. Increase skills • Bedside nurses will recognize deteriorations • Nurse practitioners on RRT can intervene • Hospitalist has high-level skills

  26. Hospitalist • Must have interventional skills • Would provide attending supervision for admissions • Support RRT • Available at night

  27. One number One call Every time

  28. Similarities to NCTF plans: • Train for skills • Hospitalist at night • Elevate skill level at bedside

  29. Differences from NCTF plans: • Dependence on RRT around the clock • Addition of APP to team • Hardwire the activation of RRT • Hospitalist to support RRT • Elevate skill level at bedside

  30. Financial Aspects

  31. Revenue • Billings for procedures • Billing for nighttime admission H&Ps

  32. Expenses • Wages • Training costs

  33. Expenses • Additional 4.5 FTE for Advanced Practice Providers

  34. Cost Avoidance • Reduce ICU admissions through early intervention • Estimated annual savings of • Reduce litigation and awards • Estimated saving of $720,000 $700,000

  35. Cost Avoidance $720,000 $700,000

  36. Summary of Recommendations • RRT as a first responder model • Consistent method of activation • Skilled nocturnist for RRT support • Measurement of outcomes

  37. Conclusions

  38. “… the most sophisticated intensive care often becomes unnecessarily expensive terminal care when the pre-ICU system fails.” Peter Safar, MD

  39. Failure to rescue … … is not an option

More Related