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.
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