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Preventing Unrecognized Deterioration and Honoring Patients’ Goals of Care by Embedding an Automated Early-Warning System in Hospital Workflows


Brian Dummett, MD; Shirley Paulson, RN, DNP; Elizabeth Scruth, RN, PhD; Julia Green, MPH; Theresa Villorente, MSN, RN; Liesel Buchner, RN, CCRN-K, CNML; Tamar Fendel, MPH; Vivian Reyes, MD; Gabriel J Escobar, MD


Abstracts from the Kaiser Permanente 2018 National Quality Conference

From Northern California

Background: Acute deterioration of hospitalized patients outside of the intensive care unit (ICU) is a preventable quality and patient safety issue that is associated with excess mortality and morbidity. The failure to recognize, communicate, or act on these early changes can lead to delays in care and adverse events, including unplanned admissions to the ICU and unexpected deaths.
Methods: We describe the impact of implementing the advance alert monitor (AAM) early warning system using a remote quality nursing team in combination with standardized hospital rescue workflows (inclusive of supportive care to ensure patient preferences are respected) to reduce inpatient and 30-day postdischarge mortality in high-risk medical surgical patients who trigger the AAM alert. We compared mortality outcomes for cases (patients who triggered the AAM alert and received the AAM standard workflow intervention) with controls (patients who triggered the AAM alert and did not receive the AAM intervention) in hospitals in the same integrated network.
Results: Our analysis describes the results from a difference-in-differences evaluation comparing the preimplementation period to the postimplementation period at Kaiser Permanente Northern California hospitals with the AAM intervention relative to those without it, adjusting for patient characteristics. Hospitals employing the intervention showed a statistically significant reduction in hospital and 30-day mortality for the patients who triggered the early warning system relative to a similar patient population at hospitals without the intervention. Several hospitals with the AAM intervention also demonstrated statistically significant decreases in length of stay.
Discussion: The AAM tool combined with review by a remote nursing team and standardized hospital workflows represents a systematic approach to reducing mortality for this at-risk population. Although AAM is the technology for proactive detection, it is only through workflow, culture change, and increased situational awareness that we can make a difference in outcomes. We are spreading this program to all hospitals in Kaiser Permanente Northern California. AAM is a first step toward a vision where predictive analytics and remote monitoring ensure that acutely ill patients remain safe from harm, and their goals are incorporated into treatment decisions before adverse outcomes occur.

Abstracts from the Kaiser Permanente 2018 National Quality Conference


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