A Systems Approach to Design and Implementation of Patient Assessment Tools in the Inpatient Setting

McGrath, Susan; Perreard, Irina; Ramos, Joshua; McGovern, Krystal M; MacKenzie, Todd A.; Blike, George T.

doi:10.1108/s1474-823120190000018012

Cited by 6 publications

(9 citation statements)

References 61 publications

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“…Study data also represent baseline performance against which the impact of such interventions can be assessed. More details related to FTR event mitigation and rescue system intervention design and measurement based in part on this work can be found elsewhere [21,34].…”

Section: Discussionmentioning

confidence: 99%

Characterizing rescue performance in a tertiary care medical center: a systems approach to provide management decision support

McGrath

MacKenzie

Perreard

et al. 2021

BMC Health Serv Res

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Background Allocation of limited resources to improve quality, patient safety, and outcomes is a decision-making challenge health care leaders face every day. While much valuable health care management research has concentrated on administrative data analysis, this approach often falls short of providing actionable information essential for effective management of specific system implementations and complex systems. This comprehensive performance analysis of a hospital-wide system illustrates application of various analysis approaches to support understanding specific system behaviors and identify leverage points for improvement. The study focuses on performance of a hospital rescue system supporting early recognition and response to patient deterioration, which is essential to reduce preventable inpatient deaths. Methods Retrospective analysis of tertiary care hospital inpatient and rescue data was conducted using a systems analysis approach to characterize: patient demographics; rescue activation types and locations; temporal patterns of activation; and associations of patient factors, including complications, with post-rescue care disposition and outcomes. Results Increases in bedside consultations (20% per year) were found with increased rescue activations during periods of resource limitations and changes (e.g., shift changes, weekends). Cardiac arrest, respiratory failure, and sepsis complications present the highest risk for rescue and death. Distributions of incidence of rescue and death by day of patient stay may suggest opportunities for earlier recognition. Conclusions Specific findings highlight the potential of using rescue-related risk and targeted resource deployment strategies to improve early detection of deterioration. The approach and methods applied can be used by other institutions to understand performance and allow rational incremental improvements to complex care delivery systems.

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Section: Discussionmentioning

confidence: 99%

Characterizing rescue performance in a tertiary care medical center: a systems approach to provide management decision support

McGrath

MacKenzie

Perreard

et al. 2021

BMC Health Serv Res

Self Cite

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“…A possible justification for continuity of research is the fact that the primary outcome of hospital mortality does not present, so far, significant positive results that point to an ideal score (25) . There were many benefits, such as an increase in activation of RRT, in the number of early admissions to ICUs, a reduction in the occurrence of cardiac arrest in the wards, but the reduction in overall hospital mortality was not impactfully achieved by the technologies studied (2) .…”

Section: Retrospective Observational 3bmentioning

confidence: 98%

“…Hospitalization raises a greater demand for care and requires monitoring by a multidisciplinary health team so that the state of health can be safely reestablished (1) . Individuals who experience the hospitalization process are susceptible to an unfavorable evolution of the pathology presented, which can culminate in complications and increased mortality, if this progressive worsening, the deterioration of their clinical condition, is not observed in a timely manner (2) .…”

Section: Introductionmentioning

confidence: 99%

“…When there is ongoing physiological deterioration, the installation of a condition compatible with the worsening of the disease is intuitively preceded by physiological parameters (3) . Any scale or scoring system that produces a score capable of classifying the risk of clinical deterioration of hospitalized patients, before its installation, is considered a technology to predict clinical deterioration (2) . It enables the prevention of unfavorable outcomes in sectors where monitoring of vital signs is not continuous and the number of patients under observation by the team is greater, such as in clinical-surgical wards (2)(3) .…”

Section: Introductionmentioning

confidence: 99%

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Technologies used by nursing to predict clinical deterioration in hospitalized adults: a scoping review

et al. 2022

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Objective: to map the early clinical deterioration technologies used in nurses’ professional practice in the care of hospitalized adult patients. Methods: this is a scoping review, according to Joanna Briggs Institute Reviewer’s Manual, which seeks to map the main technologies for detecting early clinical deterioration of hospitalized patients available for use by nurses, summarizing them and indicating gaps in knowledge to be investigated. Results: twenty-seven studies were found. The most present variables in the technologies were vital signs, urinary output, awareness and risk scales, clinical examination and nurses’ judgment. The main outcomes were activation of rapid response teams, death, cardiac arrest and admission to critical care units. Final considerations: the study emphasizes the most accurate variables in patient clinical assessment, so that indicative signs of potential severity can be prioritized to guide health conducts aiming to intervene early in the face of ongoing clinical deterioration.

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“…Another strategy to improve the detection of patients that can be deteriorating is the use of continuous monitoring in general wards, that can provide dynamic information about the patterns of the vital signs of the patient, and there can also be achieved an automation of the calculation of scores to trigger an escalation of care [20][21][22][23][24]. These automated programs also can be used in the ICU context, where is already continuous monitoring to help prevent FTR events in this setting [25].…”

Section: Introductionmentioning

confidence: 99%

Failure To Rescue, What Can Be Done To Prevent It?

Pedro

Maria

Humberto

2021

EJBMR

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Introduction: Failure to Rescue (FTR) is the failure to prevent a patient’s death after a complication. It measures the ability of a hospital to prevent the death of patients who develop one or more complication that was not present at the time of admission. Therefore, the aim of this study is to review the factors that contribute to FTR, and the measures and strategies that can be applied to prevent the FTR events, in order to discuss the best way to improve patient outcomes in the hospital setting. Methods: A search was conducted on PUBMED retrieving a total of 464 articles. A review of the selected articles’ bibliography was conducted to find other relevant articles. Sixty studies were reviewed in this paper. Results: Patient factors as increasing age, comorbidities and frailty increase the risk of FTR, as well as an increasing number of complications. Several hospital factors, nursing care, and microsystem also influence FTR. Some track and Trigger Systems (TTS) and Early Warning Scores (EWS) have been shown to predict clinical deterioration. On the other hand, machine learning systems have outperformed EWS. Rapid response teams have become the standard approach to delivery and escalation of care, and cognitive aids and crisis checklists also have potential to help reduce FTR. Conclusion: Patient and hospital factors are often non-modifiable; thus, microsystem factors could be a target for improvement. Creating clinical pathways can improve surveillance, and communication tools like SBAR can help relay information. EWS, machine learning models and continuous monitoring are strategies that can help detect clinical deterioration. In the efferent limb rapid response teams have shown to reduce FTR.

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A Systems Approach to Design and Implementation of Patient Assessment Tools in the Inpatient Setting

Cited by 6 publications

References 61 publications

Characterizing rescue performance in a tertiary care medical center: a systems approach to provide management decision support

Characterizing rescue performance in a tertiary care medical center: a systems approach to provide management decision support

Technologies used by nursing to predict clinical deterioration in hospitalized adults: a scoping review

Failure To Rescue, What Can Be Done To Prevent It?

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