MORTALITY REDUCTION ASSOCIATED WITH PROACTIVE USE OF EMR-BASED ACUITY SCORE BY AN RN TEAM AT AN URBAN HOSPITAL. Issue 11 (22nd October 2015)

• Record Type: Journal Article
• Authors: Rothman, Michael; Rimar, Joan; Coonan, Sheila; Allegretto, Stephen; Balcezak, Thomas
• Is Part Of: BMJ quality & safety. Volume 24:Issue 11(2015)
• Page Start: 734
• Page End: 735
• Publication Date: 2015-10-22
• Subjects: Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2015-IHIabstracts.21
• Languages: English
• ISSNs: 2044-5415

Abstract

Abstract : Background: Early identification of clinical deterioration is critical in providing high quality care to hospitalized patients. Having invested heavily in electronic medical records, hospitals are leveraging EMR data to address failure to rescue occurrences. The Rothman Index (RI), an acuity score which provides a graphical view of patient condition using EMR vital signs, lab results and nursing assessments, can be used to monitor patient condition. Objectives: To determine if risk-adjusted mortality could be decreased with implementation of a nursing SWAT team, using RI graphs, to identify clinically deteriorating patients at a 350-bed hospital campus. Methods: Each shift the SWAT nurse reviewed the RI graphs of all adult medical-surgical patients and pro-actively rounded on patients with the lowest or sharply declining scores who were not in an ICU. The study had a 6-month control period and a 9-month intervention period. A second control was provided by a sister campus for the 15 month period. Results: Mortality fell from 1.9% to 1.3% (p<.001) in a patient population of 24, 637. The percent of highest risk patients (admit APR Risk of Mortality 3 and 4) increased (20.3% to 22.8%) and the percent of discharges to hospice decreased (1.9% to 1.5%) during the intervention period. The mortality at the sister campus remained steady at 2.3% (population 55, 991) during the 15-months. Conclusions: Use of an EMR-based acuity index by a new, dedicated SWAT team was associated with a 30% mortality reduction. This represents an important use of the EMR to improve deterioration identification and thus quality of care.Figure 1 Figure 2 Figure 3 Table 1