Building A Virtual Nursing Team: Implementation of the Advance Alert Monitor



 

Laure E Lisk, RN, MS, CPHQ, CPHRM; Elizabeth Scruth, RN, PhD, MPH, CCNS, CCRN, FCCM; Vanessa Martinez, MSN, MPH, RN; Bronwyn Cox, MSN, RN; Kris Wilson, RN, MSN, CPHQ

https://doi.org/10.7812/TPP/19-039-39

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Northern California

Background: Implementation of the Advance Alert Monitor (AAM) program has allowed us to create and to operationalize a virtual nursing care team that provides 24/7 support and consultation for inpatient adult medical/surgical population. The program comprised more than 30 critical care-experienced registered nurses with postgraduate education and leadership skills. Regionwide adoption of the AAM program resulted in the need to develop the infrastructure to manage a series of complicated workflows that ensure systematic implementation and feedback mechanisms for the virtual team.
Methods: Virtual team development began in July 2016 concurrently with the AAM pilot implementation at a single medical center. A small nursing team was formed to provide oversight up to 16 hours per day. Additional AAM implementation occurred throughout 2017. Significant staffing increases supported 24/7 monitoring beginning in October 2017. Full implementation to all 21 facilities will be completed by December of 2018. The virtual team developed structured work processes and communication techniques to build best practices and enhance their relationship with the hospital-based team, composed of the hospital-based specialist, rapid response team nurse, and leadership; this was paramount to the success of our team.
Results: Recent data released by Gabriel Escobar, MD, and the Department of Research revealed a statistically significant reduction in hospital and 30-day mortality rates for the patients who triggered the early-warning alert relative to a similar patient population at hospitals without the intervention. AAM has proved its ability to predict patients who may decompensate within a 12-hour time frame since 2017. Creation and continual evaluation of a sustainable workflow, virtual team growth to accommodate 24/7 coverage, and meeting rigorous timelines have been significant milestones throughout 2017 and 2018. We also simultaneously transitioned our program from a Web-based application to a dashboard built within our own electronic medical record system (Kaiser Permanente HealthConnect).
Discussion: Some key identified areas for successful team engagement include developing clear communication techniques, a rhythm within the team including regularly scheduled meetings, and leveraging available technologies. A shared leadership model, which creates opportunities to involve others, has been shown to increase engagement. When creating a clinical virtual nursing team, professional experience is essential, and the ability to use critical thinking skills and independent decision making is paramount. Specific competencies required for these nurses include technical training, critical thinking, and problem-solving skills, additionally, interest in looking to future opportunities, willingness to change, and a passion for providing safe care for our members.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


 

Promising Methods for Improving Quality Through the Faster Spread of Best Practices

Abstracts2019TableThese abstracts reflect the critical importance of a forum for presenting promising quality efforts. Meetings focused on quality improvement, such as those hosted by the Institute for Healthcare Improvement, the American Medical Group Association, and many other organizations, represent a relatively small percentage of all scientific medical meetings. The publication of abstracts from a dedicated quality event such as the Kaiser Permanente National Quality Conference allows those inside and outside of Kaiser Permanente to learn about new and potentially unfamiliar practices that could improve care.

BEHAVIORAL HEALTH

The Impact of an Innovative Patient-Practitioner Therapeutic Community on the Management of Chronic Pain
Karen Peters, PhD; Barbara Gawehn, RN, LAc

Zero Suicide Implementation
Jacqueline Ryan, MPH; Pavan Somusetty, MD; Han Liang, MD; Eli Pahl, LCSW, CADC III;

Implementation and Dissemination of Cognitive Behavioral Therapy for Depression in Kaiser Permanente Hawaii: Impact and Lessons Learned
Bradley E Karlin, PhD, ABPP; Gregory K Brown, PhD; Shari Jager-Hyman, PhD; Kelly L Green, PhD; Michi Wong, PhD; Diane S Lee, LCSW, CSAC; Andrew Bertagnolli, PhD; Thekla Brumder Ross, PsyD

Lessons from Implementation of Behavioral Health Integration in Kaiser Permanente Washington
Rebecca Parrish, MSW; Ryan M Caldeiro, MD; Amy Lee, MPH

WELL BEING

100,000 Quitters and Counting—Striving for a Tobacco-Free Generation
Renee Fogelberg, MD; Mariko Muzzio, MPH; Annida Brunato; Karin Dove, MPH; Debora Sawyer, MD; Christopher Lee, MHSA

The POWER Journey of a Mid-Atlantic Permanente Medical Group Physician (Pursuit of Wellness, Engagement, and Resilience through Social Support)
Susan Leggett-Johnson, MD, MBA; Gene Gincherman, MD; Mary Zmuda, MPH

Malama Ola—Taking Care of Your Well-Being
Sharin Sakurai Burton, MD, PhD; Casey Akana, RN; Sandra Tompkins, RN; Kristy Yoshikawa; Julia Gregory, RN; Hyewon Jun, MD; Mae Lynne Swoboda, MPH; Courtney Farris, MA, MINTee; John Banagan, MPH, CHES; Eric Kamimura, DPT; Steve Nakata, COTA, MBA; Derek Chee, DPT; Quyen Nguyen, PhD; Jennifer Davis, RD; Kimberly Oshita, RD; Merle Miura-Akamine, MD; Kaipo Pau, MD; John Sheehan, MD

Increasing Team Safety and Response to the Threatening Member
Bradley Christie, PhD; Laura Ketterman, HEM

CARE MANAGEMENT

Continuing Care Quality Management: Practice, Performance, Proof
Peter Khang, MD, MPH, FAAFP; Jennifer Cortez; Christine Jordan, LCSW; Artem Aghourian, MBA

The Hepatitis C Care Cascade: Increasing Comprehensive Screening and Diagnosis
M Cabell Jonas, PhD; Michael Horberg, MD; Jacquelyn Redd, MD; Dana Sloane, MD; Eric Wollins, MD; Carla Rodriguez, PhD; Bernadette Loftus, MD

Measuring Diagnostic Error: A Review of Patient Complaints
Michael H Kanter, MD; Lawrence D Lurvey, MD; Kerry C Litman, MD; Ronald K Loo, MD; William Strull, MD; Mimi Hugh, MPH, MA; Maverick Au

No Place Like Home: Surgical Home Recovery
Michele Knox, MD; Wendy Rabinov, MD; Michael Nwynn, MD; Ashima Garg, MD, PhD; James Chang, MD; Claire Spanbock, MBA, RN, CNOR; Edgar Servais; Bijal Shah, MHSA; Tamar Fendel, MPH; Annie Davis, MPH; Joeffrey Hatton, MBA

Mid-Atlantic States Chronic Heart Failure Program
Farzaneh Sabi, MD; Machelle Behzadi, MHA; Betty Rice; Jessica Kane; Blair Van-Horn

Patient-Centered Management for Chronic Disease—A Model Applied to Parkinson Disease Care in Southern California
Jason Cheves, MSBA; Steve Cedrone, MBA; Todd Sachs, MD; Kathy Kigerl, RN, MN

Coordinated Regionwide Care Management Intervention for Patient with Chronic Obstructive Pulmonary Disease at Risk of Acute Exacerbation Reduces Hospital Days
Richard Mularski, MD, MSHS, MCR; Sanja Uskokovic, MS, PMP; David M Mosen, PhD; Bryan L Skalberg, MS; Achikam Haim, PhD; Marianne C Turley, PhD; Nancy L Lee, RPh; Wui-Leong Koh, MD

Decreasing Sleepless Nights for Patients and Practitioners by Fast Tracking Patients with Diagnostic Images Highly Suspicious for Cancer
Rischl Alindogan, BSN; Brian Doerning, MD; Robert Lin, MD; Jamie Difiori, MD; Harold Chow, MD; James Carter, RPA; Cynthia Payne, PhD

Combining Minimally Invasive Thoracic Surgery Techniques and a Multidisciplinary Care Model Leads to Superior Outcomes
Brian Timm, PA-C; Christopher Mutrie, MD; Piotr Starosta, PA-C; Julie Faulk, PA-C; German Collazo, PA-C; Yong Shin, MD; William Shely, MD; Thomas Lampros, MD; David Tse, MD

Patient-Centered Redesign of Total Joint Replacement Care: Achieving the Quadruple Aim
Kate Koplan MD, MPH, FACP, CPPS; Violeta Rabrenovich, MHA, CHIE

HIV/AIDS: A 30-Year History of Care Delivery
Patricia L Philbin, RN; Karen Lewis Smith, MHA; Susan McDonald, RN, MSN; Kathy Brown MD, FACP, AAHIVS; Dan Kent, PharmD

Enhancing Dispositions from the Emergency Department—the Northern California Journey to Care for Increasingly Complex Populations
Rayne Soriano PhD, RN; Vivian Reyes, MD; Jo-Ann Griffin, RN

Mid-Atlantic States Hospital Patient Day Rate Reduction
Farzaneh Sabi, MD; Pam Galley, MAOL; Claire Pagano, MHA; Blair Van-Horn

Preventing “Silent Droppers”: Standardizing Interventions to Prevent Lung Function Decline in Patients with Cystic Fibrosis
Jennifer Bass, MD; Adrienne Aldredge, MS; Ashley Addington; Richard Cohen, MD; Megan Danish; Susan Mikkelsen, MD; Kay Pasquesi; Kimberly Rondeau; Megan Wackford; Eric Walter, MD

EQUITY

Igniting an Inclusive Movement—Utilizing ILEaD (Inclusively Leading Through Equity and Diversity)
Laura Long, MBA; Susan Terrill

Addressing Disparities in Health with Motivational Interviewing
Deborah Baker, PhD; Hyewon Jun, MD, MPH; Dee Keyser; Peggy Latare, MD

The Community Action Poverty Simulation
Lakiesha C Tidwell; Madalynne Wilkes-Grundy, MD; Shari G Chevez, MD; Anna Khachikyan

MEDICATION MANAGEMENT

Reducing Opiate Use in Children and Teens: A Strategic Approach to a National Challenge
Anna Grosz, MD

Impact of Medication Reconciliation Programs on Reducing Readmission Rate and Enhancing Medication Safety During Transitions of Care
Alfonso Becerra, PharmD; Donald Yee, RPh; Karen Cham, PharmD; Sheireen Huang, PharmD; Shubhi Nagrani, PharmD; Adenola Akilo, PharmD; Karina Briones, PharmD; Kelvin Chan, PharmD; Carolyn Woo, PharmD; Chad Friday, RPh

PATIENT ENGAGEMENT

Human-Centered Design at Kaiser Permanente: A Creative Approach to Problem Solving
Jeff Hall; Connor Shea; Estee Neuwirth, PhD

Meeting Members’ Wishes in the Last Year of Life: A Journey Toward Concordance in Southern California
David Glass; PhD Michael Kanter, MD; Paul Minardi, MD; Susan Wang, MD

Using Insights from End-of-Life Care Survey to Drive Improvement of Care at the End of Life
Margaret C Wang, PhD, MPH; Diane Brown, PhD, RN, FNAHQ, FAAN; Peter S Khang, MD; Ruma Kumar, MD

Reducing Preventive Flips to Diagnostic—A Holistic Approach to Improving the Financial Experience for Members
Peter Gazanian; Erin Bilvado, MBA

TOTAL HEALTH

How Healthy Is My Community—Designing a Measurement System for Leaders and Implementers
Pamela M Schwartz, MPH; Elisa Wong, MPH; Allen D Cheadle, PhD; John M Vu, MPH

If You Want to Know How Mrs Smith is Doing, Ask Her! KP’s Improved Medicare Total Health/Social Risk Assessment
Tracy Lippard, MD, FACP; Carole Gardner, MD, AGSF; Matt Stiefel, MPA, MS; Ranu Pandey, MHA; Juliana Oronos, MPH

Bridging Barriers to Care Access and Delivery: The Automation of Nonemergent Transportation in Kaiser Permanente Mid-Atlantic States
Kyle M Heidenberger; Rachel E Hill; Melissa Baldwin, MS, MBA; Jason C McCarthy, PharmD, MBA

Addressing Social Needs: Organizational Learnings and Connecting with Our Communities
Sarita A Mohanty, MD, MPH, MBA; John F Steiner, MD, MPH; Nicole Friedman, MS; Briar Ertz-Berger, MD, MPH

TEAMS

The Kaiser Permanente Northwest Ventricular Assist Device Program
Barbara Amos, RN, MSN, CNS; Timothy Jacobson, MD; Yong Shin, MD; Ryan Morrissey, MD; Siobhan Gray, MD; Pamela Montes, RN, MSN; Allison Lipnick, LCSW

In-Basket Management: Empowering Nurses to be First Responders for Patient Messages, Providing The Right Care at The Right Time
Dones M Trojillo, MSN, RN; Maia M Patel, MD, ScM

The Implementation of High-Reliability Organization Model for the Environmental Services Department at Santa Clara Medical Center
Eric Williams, MHSA; Kari Frank, MS; Marc Smith, MHA

Building A Virtual Nursing Team: Implementation of the Advance Alert Monitor
Laure E Lisk, RN, MS, CPHQ, CPHRM; Elizabeth Scruth, RN, PhD, MPH, CCNS, CCRN, FCCM; Vanessa Martinez, MSN, MPH, RN; Bronwyn Cox, MSN, RN; Kris Wilson, RN, MSN, CPHQ

Improving Quality and Safety Together: Reducing Primary Cesareans Perinatal Core Measure Collaborative
Lyn Yasumura, MD; Cheri Lowre, MD; Leslie Casper, MD; Marianna Volodarskiy, RN, MSN, NE-BC

TECHNOLOGY

Leveraging Technology to Improve Appropriate Imaging Studies: There’s an App for That!
Peter Huynh, MD; Paymann Moin, MD; Michael Flores; Pamela Galvan; Steven Ethington

Using Human-Centered Design to Expand Telehealth Into the Hospital and Continuum
Reema Shah MPH; Estee Neuwirth, PhD; Lan Nguyen; Carissa Lim; George Go, MD; Tamara Hillstrom; Dan Huynh, MD; Margaret Pierce; Colette Lundahl; David Miura; Lisa Arellanes

Home Health Virtual Complexivist Physician Program: Leveraging Increased Scope of Care at a Crucial Time
Alicia Ahn, MD; Sandra Barton, MD; Binitha X Surendran, MBA, MS

Improving Patient Safety Via Information Transparency and Performance-Improvement Infrastructure
Asia Plahar, MS, RN; Kathy Ricossa, MS, RN

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