In her August 9th opinion piece in The New York Times, titled “How to Quantify a Nurse’s Gut Feelings,” hospice nurse Theresa Brown says, “working at the bedside has honed nurses’ perceptions to be especially alert to brewing trouble.” She praises PeraHealth’s clinical surveillance with the Rothman Index (RI), because it validates that “clinical instincts matter.”
The RI helps warn care providers of patient deterioration before it becomes critical by drawing on hundreds of data points from the EHR, including nursing assessments, vital signs, laboratory results, and admission/discharge/transfer (ADT) data. Head-to-toe nursing assessments, capturing the clinical instincts Brown speaks of, are a unique and proprietary element of the RI calculation and are proven to identify functional deterioration before vital signs or laboratory data..
Brown’s article has generated more than 400 online comments from patients, physicians, and nurses…providing a cross sectional view into age-old debates on teamwork, communication, technology, processes, and policy.
Main themes in the online discussion include:
Gut feelings are not really feelings
Brown defines these feelings more accurately as “agglomerations of observations and experiences that over time have turned into finely tuned clinical judgment.”
Another nurse’s comment calls them “experiential intuition.”
And a physician’s comment clarifies that “hunches” should always be taken seriously and followed up with objective testing.
Bringing it all together, the judgment of multiple team members works hand-in-hand, as illustrated in this example from one reader who prefers the phrase “informed instinct”:
“In the ER a good example of this teamwork is a triage nurse's assessment that a patient can't wait to be seen by the physician. And a physician's assessment that a patient is well enough for discharge. Both are clinical judgements that are made multiple times in a shift. Sometimes someone gets it wrong. But both physicians and nurses rely on this informed instinct.”
Communication skills are critical, and care team members need a common language
Effective communication makes a difference for patients. Situational awareness and critical thinking skills help team members efficiently convey messages. One familiar communication technique for important information is the “SBAR” (Situation, Background, Assessment, Recommendation) method.
On the other end of communication is receiving. As one reader puts it, “The key word in the story and in all the comments is listen.”
And another shared, “I cannot say enough about the ER nurse who listened to me this past spring concerning what I noticed in my supposedly fine-for-release family member. Credit also goes to the doctor who then listened to the nurse, asked to speak directly to me, and emphasized how important the info. I provided was. She admitted my family member…The story ended well after a seven-day stay.”
Technology must support, not interfere with, clinical experience and human judgement
Any technology is only as good as the people and processes that surround it.
One reader states, “If the data in medical records is useful to a physician or nurse, then it should be possible for the computer to be programmed (as it has with the Rothman Index) to recognize trends that are not obvious to clinicians. And again, if data are useful to clinicians, then computers, as masters of data manipulation rather than merely storage, can be great aides in diagnosis. I submit that is the true benefit of electronic medical records. All else is commentary. Watson, let the programming begin.”
Patients and their families are part of the care team
Espousing better patient and family engagement, one reader says, “Also crucial to being an excellent nurse is the ability and inclination to listen carefully to the patient’s family member(s). Close family can sometimes pick up on the patient seeming ‘off’ when medical staff cannot, and sometimes that family can articulate in what ways s/he is off. The nurse can then tune in to the signs and/or can intervene with the doctor on the patient’s (and family’s) behalf.”
Integration with the clinical workflow makes strategies stick
Teams must agree on and implement processes and protocols to sustain any quality improvement.
Regarding gaps in communication, one reader states, “To help fight this human failing, our hospital has instituted daily interdisciplinary bedside rounding in which every member of the team from the patient to the attending physician has a voice.”
Safety huddles are another popular strategy to close communication gaps.
Using the RI is a way to ingrain proactive, advanced clinical surveillance into a hospital’s clinical workflow. One physician’s comment provides a nice summary: “In the end, we’re all humans trying to do the best we can to help patients with the resources we have. The more we can use creative technology to help, the better!”
To hear the story behind the RI and learn more about the model The New York Times readers are buzzing about, register for our September 6th webinar titled, “Proactive Rounding Based on Clinical Surveillance: A Team Approach for Rapid Response and Better Patient Outcomes.” Two health systems will share their approaches for proactive rounding with the RI and how they capture and use valuable input from all members of the care team.