Poster Session HRT11420 Innovation Awards November 2014 Melbourne Improving the referral rate of deteriorating patients to the ICU Liaison service. Presenter: Anna Green / Kelly Habjan Hospital Code Name: Western Health
Elevator Pitch- Rounding for the deteriorating patient found that the rapid response team were being referred patients on the dying pathway in which ward staff were requesting assistance. Results 60.2% increase in deteriorating patient referrals post rounding 545.5% increase in maternity referrals via rounding 661% increase in emergency referrals via rounding 14% reduction in unplanned ward admissions to the ICU post rounding 31.6% reduction in mortality rate for unplanned ward admissions to ICU post rounding 36.4% reduction in the number of code blue calls post rounding 85.3% increase in deteriorating patient referrals with worried criterion post rounding 38.5% increase in referrals for end of life care patients post rounding
Presenters Summary 1. Key problem: Ward staff are not referring all patients with deterioration to the rapid response team. 2. Low referral rate from emergency and obstetric areas. Aim of Innovation: To increase the number of patients referred to the rapid response team via rounding. What we did: Rapid response team undertook rounding to each clinical area and the emergency department. Outcomes: Large increase in referrals for patients with the worried criterion Many of these patients were on the dying pathway (unrecognised) Decreased in unplanned ward admissions to the ICU Decrease in hospital mortality rate from unplanned ward admissions to the ICU
KEY PROBLEM 1. Ward staff are not referring all patients with reportable vital signs to the nurse-led rapid response team. 2. Low referral rate from emergency and obstetric areas. Deteriorating patient referrals to the ICU liaison nurse Yes Afterhours Code blue Missing data Not escalated 6% 9% 12% 40% 33% Nb: 2 patients who had a code blue had abnormal vital signs 8 12 hrs preceding the event.
AIM OF THIS INNOVATION 100% of patients with reportable vital signs will be referred to the nurse-led rapid response team. To increase the number of patients referred to the nurse-led rapid response team via rounding. To reduce the number of unplanned admissions to the Intensive Care Unit from the wards. To reduce the number of code blue calls. To improve the mortality rate from unplanned admissions to the ICU.
BASELINE DATA
KEY CHANGES IMPLEMENTED 1. 2hrly rounding to each ward at both Western and Sunshine hospitals. 2. Developed an audit tool. 3. Education provided re escalation criteria. Inform NUMs of the rounding project. 4. Commenced rounding in the emergency departments. 5. Energize and motivate ICU liaison nurse consultants
OUTCOMES SO FAR Pre Data No. of patient reviews 60 50 40 30 20 10 0 Number of Patient Reviews from rounding referrals in new areas Pre (Apr12 - Sept12) and Post (Oct 12- Mar14) Apr-12 Jun-12 Aug-12 Oct-12 Dec-12 Feb-13 Apr-13 Jun-13 Aug-13 Oct-13 Dec-13 Feb-14 Apr-14 Maternity Emergency - SH Emergency WH 140 135 130 125 120 115 110 105 Number of Unplanned ward admissions to ICU pre and post rounding 136 Pre Apr12- Sept12 117 Post Oct12- Mar13 125 Post Apr13- Sept13 123 Post Oct13- Mar14 40 35 30 25 20 15 10 5 0 Western Hospital Mortality rate from unplanned ward admissions to ICU 38 26 22 29 Pre Apr12-Sept12 Post Oct12 -Mar13 Post Apr13-Sept13 Post Oct13-Mar14
OUTCOMES SO FAR Rounding for the deteriorating patient found that the rapid response team were being referred patients on the dying pathway in which ward staff were requesting assistance.
LESSONS LEARNT Rounding has got the ICU Liaison team involved in the earlier detection of the end of life care(eolc) patient. Dying patients are poorly managed especially on the ward and the ward staff require assistance. The use of a clinical indicator tool (SPICT) may be beneficial in the identification of patients at risk of deterioration and dying. Nursing staff are unable to make a palliative care referral without medical approval. Competing projects on the ward reduced buy in Within Western Health there are inconsistencies amongst medical units for identifying and caring for the dying patient.
Who can provide information on this innovation from your service? Anna Green: anna.green@wh.org.au Gary Blackburn: gary.blackburn@wh.org.au