For many hospitals, the shift to value-based care is adding pressure to deliver quality care and achieve the best clinical outcomes while reducing costs. Saratoga Hospital in Saratoga Springs, New York, was one such hospital facing these challenges as they tried to adapt to delivering higher quality, accessible and affordable care to aging populations with increasing incidences of chronic diseases.
THE PROBLEM
In New York State alone, more than 40 percent of adults suffer from a chronic disease, which is responsible for 23 percent of its hospitalizations, according to state data. That high number often makes for a hectic, overcrowded general ward. In these scenarios, it is often difficult for caregivers to determine which patients are at the greatest risk of having an unexpected serious adverse event such as cardiac arrest.
Caregivers at Saratoga Hospital were taking patients' vital signs every four hours, and this information would be manually logged into the electronic health record to be further assessed by nurses. This spot-checking made it difficult for nurses to identify indications that a patient was deteriorating.
PROPOSAL
In an effort to minimize preventable adverse events, Saratoga Hospital implemented a Philips patient monitoring system to eliminate patient codes and reduce patient transfers to the intensive care unit. Philips IntelliVue Guardian helps streamline the manual process by automating the scoring that aids clinicians in identifying deviations in a patient's vital signs, according to the hospital.
MARKETPLACE
There are many patient monitoring systems on the market today. Vendors include Biotronik, Leaf Healthcare, MD Revolution, Medtronic, Nihon Kohden, Philips Healthcare, Spacelabs Healthcare and Welch Allyn.
MEETING THE CHALLENGE
Saratoga Hospital leveraged a modified early warning score protocol, an algorithm supported by the Philips IntelliVue Guardian Solution, which streamlines the manual process of entering vital signs into the EHR and automates the scoring that aids clinicians in identifying deviations in a patient's vital signs, said Diane Bartos, RN, the hospital's director of critical care.
"This early identification occurs hours before a potential adverse event, giving Saratoga's clinicians time to intervene prior to patient deterioration," she added.
The technology is used by clinicians and integrates with EHRs via Philips IntelliBridge Enterprise, an interoperability system, to send patients' vital sign information directly into the system to be further assessed, avoiding the previously manual processes, she said. It also integrates with Philips IntelliVue MP5SC vital signs monitor, which helps enhance patient care by providing patient measurements and clinical decision support at the point of care, she said.
RESULTS
Since implementing all of the technology in 2015, Saratoga Hospital has reduced patient transfers to the ICU by 63 percent.
"By leveraging Guardian and the early warning score protocol, clinicians were able to identify and detect problematic changes in patients' vital sign information hours before a potential adverse event could occur," Bartos said. "This gave Saratoga's clinicians time to intervene before a patient deteriorated and required transfer back to the ICU."
And since implementing the technology, Saratoga Hospital has eliminated patient codes – adverse events such as rapid patient deterioration or cardiac arrest – within its 20-bed orthopedic unit, which dropped from three or four codes per year to zero.
"The system empowers nurses to make confident care decisions with real-time alerts to identify subtle signs of deterioration in a patient's condition at the point of care before potential adverse events occur – allowing them to eliminate codes, making them one step closer to saving a patient's life," Bartos explained. "It also helped to save time during rounds."
ADVICE FOR OTHERS
It is important for the healthcare provider organization to hold collaborative internal discussions between physicians and nursing staff to clearly identify the organization's end goals for the new system, said Bartos.
First determine how the organization plans to use the scoring and how everyone would like the system to work once implemented, then back into the steps for carrying it out from there, she said.
"In these discussions, think about how the organization would like to hold caregivers accountable for using the system," she advised. "Consider whether to use it as a quality indicator, a personnel evaluation tool, or both, in addition to its primary function. Deciding these uses ahead of time will help the vendor and organization work together to set up the system to best meet organizational needs from the beginning."
Those initial discussions should include establishing collective buy-in from all parties – physicians, nursing leadership, nurses and advanced practice providers, she said. Total buy-in, she said, can make a difference in how well clinicians and caregivers adapt to the technology.
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