Many hospitals have instituted rapid response teams (RRTs) to prevent potentially avoidable deaths in general medical surgical unit patients. However, studies to date have not found consistent improvement in clinical outcomes as a result of these RRTs. This may be a result of RRT activation relying primarily on recognition of critically abnormal vital signs by the patient’s nurse, a process that is not always reliable. As a result, some patients may not receive timely lifesaving interventions, resulting in potentially avoidable deaths.
The purpose of our pilot EHR innovation was to ameliorate the problem of underdetection of potentially critically ill hospital patients. This goal was achieved by implementing an early warning system (EWS) that improves RRT situational awareness of patients with critically abnormal vital signs by displaying within the EHR a real‐time list of these patients.
Two lists of potentially critically ill patients are displayed within the EHR (Cerner using MPages). The first list (called the RRT list) displays inpatients with critically abnormal vital signs — defined as SBP < 90, HR > 130, RR > 24, and SaO2 < 90% — and assigns a score of 1‐4 based on the number of vital signs that meet these criteria. The second list displays the modified early warning system score (MEWS) calculated as shown in Table 1. The lists are refreshed every 5 minutes. A sample list is displayed in Figure 1. Patients in the CCU and ER are automatically excluded from the lists. Comfort care patients can be manually excluded. Short notes about patients can be entered directly on the list. Clicking on the patient opens the patient's chart. Hovering over the score displays score details. Clicking on the score shows the trend for the score. Patients can be “snoozed” off the list for varvinq amounts of time. Subsets of hospital patients can be selected bv the user (i.e., a specific floor or team). The list is viewed by the nurses that staff the RRT. When the RRT nurse sees a patient on the list that he or she is concerned about, the nurse will usually contact the patient's primary nurse to gather more data and make subsequent management decisions. The system is piloted at our 450‐bed urban university based teaching hospital in addition to the affiliated 413‐bed university‐operated county hospital.
The EWS system has been enthusiastically adopted by the RRT teams at both hospitals because they believe it has significantly improved their ability to proactively identify deteriorating general ward patients. Formal evaluation is underway to determine if this improved situational awareness of deteriorating patients results in improved clinical outcomes. The efficacy of the system is limited by the frequency that the RRT nurses are able to view the EWS. A pocket‐based device carried by the RRT nurses that displays the EWS may improve its efficacy.
B. Aaronson, none; D. Stone, none.
To cite this abstract:Aaronson B, Stone D, Schaft M, McMahon D, Nelson L, Young D. An Electronic Health Record (EHR) Based Tool to Aid in the Prevention of Potentially Avoidable Deaths in Non‐ICU Hospital Patients. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 107. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/an-electronic-health-record-ehr-based-tool-to-aid-in-the-prevention-of-potentially-avoidable-deaths-in-nonicu-hospital-patients/. Accessed April 3, 2020.