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January/February 2023
Technology: Life-Saving Program Combines Technology With Nursing Skills A new program focused on early detection warnings helps an Illinois hospital reduce its mortality rate and improve patient care. While patients often exhibit warning signs of an impending decline prior to it actually occurring, those signs sometimes go unnoticed before it’s too late. But critical care nurses know that the earlier they can intervene with a deteriorating patient, the better the outcome. That is a key reason why a team at Blessing Hospital in Illinois decided to implement an early warning detection system. It employs real-time alerts monitored by an experienced critical care nurse who is trained to recognize changes indicating a worsening condition. That program, which started out in pilot form, is now being fully deployed with great success, according to a team of nurses involved. Eydie Tipton, MSN, RN, CCRN-K, CNML, a nurse researcher at Blessing, was part of the team that implemented the program. She says a key component to its success was the combination of early detection technology along with what they call a “HART Nurse.” That stands for High-Acuity Response Team Nurse—and it’s proven to be a vital, full-time nursing position. “Having a nurse that is specifically dedicated to monitoring data to look for subtle changes in a patient’s condition has allowed us to respond to a patient before they fall into a rapid decline,” Tipton explains. “Often nurses already have that intuition—they know that something just isn’t right—and in many ways that was a precursor to this program. But now we are also using data to stay on top of this, even when things are busy and there are a lot of different patients to keep track of. That’s the HART nurse’s job, 24/7.” Laura Weigand, RN BSN, CCRN, TNS, sepsis coordinator at Blessing, is also part of that team. She says that the hospital uses two key early detection tools: The Rothman Index and Sepsis Monitor from Wolters Kluwer Health. The latter is an electronic sepsis monitoring device, whereas the Rothman Index is a proven algorithm (embedded in an EMR) that derives a score from a variety of real-time data. Weigand reports that both have been effective in delivering important patient data. Blessing has been using the Rothman Index for over a decade and has implemented the Sepsis Monitor as an additional tool in the last month. With the HART nurse looking at all of this real-time information, they can make quick decisions and use those data to their full potential. The technology is designed to alert nurses to early, subtle changes in the patient’s condition, for which interventions can be implemented to prevent deterioration. The caveat is that these tools are based on what the nurse documents in the EHR. For these tools to be optimal, nursing must make it a priority to document in real time. Weigand says that information comes directly to their phone through a secure messaging platform. This has equated to around-the-clock monitoring of changes in a patient’s vital signs and cardiac rhythm. “No matter where in the hospital they are, they can take a quick look to see why they’ve been alerted,” Weigand explains. “Then they can intervene immediately. If the system picked something up, they investigate in the electronic record or head right to the patient’s room.” Tipton says this program is preventing patients’ conditions from becoming “failure to rescue situations.” While that was always the goal, the fact that nurses often have many patients under their care has not always made it feasible. But with the combination of technology and a dedicated HART nurse, that’s changing. “If the HART nurse can notice subtle changes in a patient’s condition early on, including drops in blood pressure or rises in a heartbeat, they can quickly talk to the patient’s primary care nurse and make informed decisions,” she continues. “That means intervening early on, which ultimately improves the quality of care.” Recognizing Sepsis Sepsis, a potentially life-threatening condition caused by the body’s response to infection, is a complication characterized by a systemic inflammatory response producing symptoms such as low blood pressure, dizziness, fatigue, and chills. Because of these relatively vague symptoms, sepsis has been called a silent killer. Its symptoms are known to mimic those of other not-life-threatening conditions and could be ignored until it’s too late. It is something that Weigand is personally familiar with as her late husband, Travis Weigand, went into septic shock in 2016 during chemotherapy treatment for colon cancer. While he survived sepsis, it still left its mark. Because blood flow to his feet was impaired, it led to below-the-knee amputation on both legs. Weigand recalls being given a 5% chance of survival and remembers how “sneaky and subtle” those early signs of sepsis were. They were easily mistaken as side effects of the chemotherapy. To ultimately survive the impact of sepsis, Travis was hospitalized from the end of October until mid-December 2016 and required intensive rehabilitative care. He survived sepsis and lived for six more years before passing away in April 2022 at age 62 as a result of colon cancer. Now, recognizing sepsis early is personal for Weigand, and she is dedicated to its importance. Since any infection can put a patient at risk of sepsis, those patients who come into the hospital already experiencing infection are closely watched. Weigand says they would go on a list of patients that they refer to as the “HART list.” These are patients who are already exhibiting possible signs of a life-threatening problem or are at risk of sepsis. If a patient on that list was recently transferred out of the ICU or cardiovascular unit, the HART nurse will follow them closely for two days, making sure that they are not showing any signs of deterioration to reduce patients bouncing back to critical care. While sepsis is a critical piece of the puzzle, Tipton adds that HART nurses need to be able to be somewhat of a jack of all trades, as there are often a multitude of reasons why patients may experience sudden decline. Sepsis is one, but there are other signs and symptoms to watch for, such as those of a stroke or a sudden heart event. The HART nurse is well-versed in all of the early warning signs of various life-threatening conditions. Both Tipton and Weigand stress that keeping up with education on these signs is imperative. Finding Optimal Rapid Response Nurses “When we first implemented this program, the roles and responsibilities of what is now the HART nurse were handled by the charge nurse along with other duties,” Tipton explains. “However, as we were able to demonstrate that our mortality rate was declining, it became clear that dedicating someone to this role 24/7 had tremendous value. Our initial pilot showed a snippet of what could be achieved, and it was realized that with more time, resources, and tools, this could be something really great.” According to both Tipton and Weigand, the outcomes of this program were easy to present to nursing leadership for more support of the role. Weigand adds that the hospital has been tracking data for a long time, and with this program, it was clear that it was having a direct influence on mortality. Data also indicated that more rapid responses were called, demonstrating that these early signs of a potential decline were being spotted more regularly. Weigand says HART nurses like that they are frequently on the go and working throughout different areas of the hospital. “It is a good fit for the nurse that is a bit of an adrenaline junkie and thrives on action,” she says. “You’re doing all the rapid responses, TEMIs [transient episodes of myocardial ischemia], strokes, and traumas.” As far as a learning curve for implementing a program like this, Weigand says it’s minimal. That’s because hospitals are likely already doing rapid response. It’s just a matter of intervening earlier with the combination of technology and a dedicated nurse. “It’s all about doing more preventative maintenance,” she continues. “Another big component of this is good communication. Obviously, the technology will provide those alerts, but then it’s also about communicating what needs to be done.” Another component of the HART nurse role is to mentor other nurses across the organization. It is a vital component of being a critical thinker to recognize situations where patients are exhibiting signs or symptoms of a change in condition. The HART nurse is able to reach, guide, reinforce nursing practice, and build critical thinking skills in the nurses throughout the hospital. “We’re not only investing in the knowledge of the HART nurse but building a strong foundation for the practice of nursing throughout the organization,” Tipton adds. It’s also something that hospitals can ease into. When Blessing first began piloting this program, Weigand says they started with just the vital signs. “There is a reason why those vital signs are so important, so we started by streaming the vitals through the system and seeing if it raised any alerts,” she says. “The Rothman does require documentation of an assessment so the fastest way to do that is to look at the vitals. We started there. Then if we had questions about a patient, we could reach out through the secure messaging platform and send someone right to the patient’s room.” Better Care, Better Outcomes Though it’s obviously an upfront investment in both technology and a fulltime position, the reduction in mortality rates makes it an incredibly worthwhile venture for hospitals. Tipton says she would love to see other hospitals come up with some variation of this life-saving program at their own facilities. Weigand stresses that the combination of both the technology and the HART nurse (or some variation of that role) is what makes this program so successful. It’s important that hospitals look at implementing both to see the greatest success. “The technology is very good but what the nurse is seeing is an overview of the data,” Weigand says. “You still need a well-educated nurse to read what is on the platform and then use that data to make an informed decision.” In other words, the nurses’ intuition—and then their decision-making skills—are still playing a vital role. Both Weigand and Tipton say hospitals should do their due diligence in researching the technology available and choosing one or more platforms that will work best for their needs. Tipton, who frequently reviews literature as a researcher, says the research does demonstrate that early warning technology is going to improve outcomes. And, as their program demonstrated, when combined with a dedicated nurse reading and interpreting those data, the results can be powerful. Tipton sums up: “When the right people are equipped with the right technology, we can reduce mortality rates and improve patients’ quality of care.” — Lindsey Getz is an award-winning freelance writer in Royersford, Pennsylvania. |
