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Failure to Rescue: One hospital’s JOURNEY

Failure to Rescue: One hospital’s JOURNEY. Spalding Regional Hospital. Who we are….. Who we are …. Spalding Regional Hospital Founded in 1903 Sole community provider 160 bed facility 900+ employees 196+ affiliated physicians Owned and operated by Tenet Healthcare Corporation

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Failure to Rescue: One hospital’s JOURNEY

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  1. Failure to Rescue: One hospital’s JOURNEY Spalding Regional Hospital

  2. Who we are…..Who we are….. • Spalding Regional Hospital • Founded in 1903 • Sole community provider • 160 bed facility • 900+ employees • 196+ affiliated physicians • Owned and operated by Tenet Healthcare • Corporation • Major specialties include cardiology, general medicine, OBGYN, pulmonary

  3. To Err Is Human • Failure to Rescue is inevitable when relying solely on human cognition (Acquaviva, Haskell, Johnson, 2013)

  4. Failure to Rescue –Identification of Issue • Driven by opportunities identified by CNO and education department to make a difference in safety measures and patient outcomes • Evidence of variability in nursing responses to crisis across hospital • Used rapid cycle PDCA –of all opportunities identified, the educational component was most needed • LEAPT initiative

  5. Educational Plan With Teeth • Mandatory in-services • Around the clock in-services including weekend • 100% compliance required-if did not attend, could not work—supported by CNO • In-services completed at sister hospital and if staff missed in-service at Spalding, attended at sister facility prior to working • Interactive learning approach used including e-learning and case studies

  6. Follow-up Processes • Chain of command taught and emphasized in policy & procedure ( staff cannot be threatened or bullied into not calling MET(Medical Emergency Team) call if needed) • Every nurse in building taught, every person in building assigned e-learning in how and when to call MET call • MET team education incorporated into orientation and yearly required skills in-services. • MET call Video “Who You Gonna Call—MET team” with employee and shown on holidays, special occasions. • Feedback received from other facilities regarding the nurses who worked at Spalding, complimenting the nurses clinical knowledge and abilities in crisis situations

  7. Data review • Reviewed trends and saw opportunity in PSI 4 in 2011 & 2012: Death Rate among Surgical Inpatients with Serious Treatable Conditions

  8. Renewed interest – LEAPT project • Hospital’s focus on failure to rescue had renewed interest in 2013 • Focused specifically on surgical patients to determine if there were triggers that one could recognize prior to MET call • Monitored MET calls to determine if MET calls made a difference in number of Code blues outside of ICU---to determine if there were triggers in MET call patients that were not present in those with same diagnosis without a MET call

  9. Project Overview -Methodology • Examined records of MET call patients • All patients who experienced a Medical Emergency Team (MET) call between July 1, 2013 and December 31, 2013 on the 3W Medical/Surgical Unit • Interviewed MET call initiators, responders, physicians • Determined the frequency distribution of specific Diagnosis Related Groups (DRGs) of patients receiving a MET call • Compared and contrasted the length of stay of patients with a similar DRG with those who did not experience a MET call • Proposed a plan to help address earlier recognition of patient decompensation and/or the development of complications • Literature review

  10. Postoperative patients • 41% of post-op MET calls occurred within 48hrs following surgery

  11. Notable MET call trends • Albumin less than 3.4 g/dl – 44% • Obesity (BMI>30) – 41% • At least one co-morbidity (HTN, DM, CAD, Hyperlipidemia, CHF, COPD) – 76% • Two or more co-morbidities – 71%

  12. Comparison of LOS for DRG’s with and without MET call Study group compared to patients with the same DRG during the same period 682 335 207 392 DAYS 460 34 study patients 27 different DRGs DRG

  13. Overview of Focus Group Perceptions • Those interviewed did not perceive any trends in diagnosis or precipitating factors • Some responders felt MET calls were most often called following routine assessments and shift changes • The MET call process was not perceived to be over utilized • The process was felt to be effective • Med/Surg nurses feel direct admissions are at risk • MET team responders would like the Med/Surg nurses to be more involved in the process

  14. Conclusions • No consistent MET call risk by DRG/Diagnosis • Most patients experiencing a MET call have a longer LOS • Staff may rely on MET team for assessment rather than validation • MET calls occurred most often within 48hrs of admission • Risk factors appear to be patients with chronic illness reflected by one or more significant comorbidities; 1. morbid obesity 2. low albumin 3. HTN 4. DM 5. CAD w/wo CHF 6. COPD

  15. Recommendations • Leadership commitment at highest level • Need an accurate and visible method of determining acuity - Rothman Index is one example, another may be 12 hour lab or vital sign trend • Continued Physical Assessment Education for Med/Surg Nurses • Train MET responders to coach/educate • MET call/Code Blue Grand Rounds-continuous education • Review direct admit diagnosis to insure protocols in place for high risk diagnoses

  16. Proposed Bundle • Leadership buyin, Champion to assist with spread of concept throughout organization • Multidiciplinary team to implement MET protocols/ policies/procedures • Education of entire hospital staff-when to call and who can call a MET call (anyone and everyone) • Medical Emergency/Rapid Response team development-staff with skill set to handle emergency care-role definitions • Implementation of general preventive measures: • purposeful hourly rounding • Early detection-vs/lab trend review • Bedside reports with patient/family participation • Analyze data and provide feedback to entire hospital –Report card • Follow-up education

  17. References Acquaviva, K., Haskell, H., & Johnson, J. (2013). Human Cognition and the Dynamics of Failure to Rescue: The Lewis Blackman Case. Journal Of Professional Nursing, 29(2), 95-101. doi:10.1016/j.profnurs.2013.03.009 Finlay, G. D., Rothman, M. J., & Smith, R. A. (2013). Measuring the modified early warning score and the Rothman Index: Advantages of utilizing the electronic medical record in an early warning system. Journal of Hospital Medicine. Georgia Hospital Association (2014). LEAPT/GAPP. Retrieved from: https://quality.gha.org /Home/ Hospital EngagementNetwork /LEAPTGAPP.aspx Perahealth (2014). The Rothman Index: The New Universal Patient Score. Retrieved from: http://www.perahealth.com/solutions/rothman-index/ Rothman, M. J., Solinger, A. B., Rothman, S. I., & Finlay, G. D. (2012). Clinical implications and validity of nursing assessments: a longitudinal measure of patient condition from analysis of the Electronic Medical Record. BMJ open, 2(4). Subbe, C. P., & Welch, J. R. (2013). Failure to rescue: using rapid response systems to improve care of the deteriorating patient in hospital. Clinical Risk, 19(1), 6-11 Taenzer, A. H., Pyke, J. B., & McGrath, S. P. (2011). A review of current and emerging approaches to address failure-to-rescue. Anesthesiology, 115(2), 421-431

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