failure to rescue: one hospital’s journey spalding regional hospital
TRANSCRIPT
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
Major specialties include
cardiology, general medicine,
OBGYN, pulmonary
To Err Is Human
Failure to Rescue is inevitable when relying solely on human cognition (Acquaviva, Haskell, Johnson, 2013)
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
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
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
Data review Reviewed trends and saw opportunity in PSI 4 in 2011 & 2012:
Death Rate among Surgical Inpatients with Serious Treatable Conditions
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
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
Postoperative patients
41% of post-op MET calls occurred within 48hrs following surgery
17
10
7
All OthersPOST Op Within 48hrs
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%
Comparison of LOS for DRG’s with and without MET call
DRG
DAYS
Study group compared to patients with the same DRG during the same period
0
5
10
15
20
25
30
35
LOS with MET CallAVG LOS
299207
335
392
460
682
34 study patients27 different DRGs
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
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 albumin3. HTN4. DM5. CAD w/wo CHF6. COPD
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
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
ReferencesAcquaviva, 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