Title : Reducing predictable in hospital cardiac arrests
Abstract:
In-hospital cardiac arrests continue to have poor outcomes. The addition of rapid response teams (RRT) produced meaningful impacts in the early years of the new millennium. Since then, most health systems have implemented a process to provide emergency assistance at the bedside with hopes of implementing earlier interventions for clinical deterioration. However, the nursing shortage and lack of experienced caregivers have reached a tipping point. The instinct to know when to call for help that comes with experience is missing in the junior nurses and gone are those mentors who were available at the bedside to provide crucial input needed to facilitate professional development. To help fill the gap of staffing and experience, we looked at implementing an early warning score, and in 2019, our hospital adopted the Electronic Cardiac Arrest Risk Triage (eCART). eCART continually monitors hospitalized patients using real-time EHR data and artificial intelligence, identifying patients at risk for clinical deterioration, and provides a fully integrated workflow for assessing and managing this vulnerable population. Additionally, we updated our protocols to have the RRT proactively evaluate at-risk patients identified by eCART, providing expert consultation and real time education to the bedside nurse. To measure our success, ward cardiac arrests are reviewed regularly and categorized as predictable or non-predictable based on any elevation detected by eCART within 24 hours of deterioration. Our aim is to reduce predictable ward arrests. By providing a live risk score with an integrated clinical workflow to our frontline nursing team and a proactive approach that includes direct patient assessment by our RRT, our predictable cardiac arrest rate has decreased steadily since integration and is now one of the lowest for our health system.
Audience take away notes:
- Creative approaches to effective patient surveillance require outside the box thinking given the nursing crisis
- Adjusting workflow to target weaknesses will assuage additional burden on both RRT and ward staff
- The combination of an electronic warning system coupled with proactive rounding can reduce predictable cardiac arrests.
