In a December 2017 white paper titled, "Shifting from Reactive to Proactive Care Delivery: Strategies for Improving the Effectiveness of Rapid Response Teams," I argued that the standard rapid response team model can be improved. My recent trip to Manchester, U.K., for the International Conference on Rapid Response Systems and Medical Emergency Teams confirmed my belief.I interacted with experts from across the U.K., Europe, Asia, Australia, and the U.S. The variety of topics was a great reminder of what a dynamic and important space we work in. At the core, we discussed system infrastructure, the patient perspective on Rapid Response systems, inter-disciplinary communication, and empowering front-line staff.
Unofficial themes always emerge throughout the course of the conference – last year it was sepsis, this year, it was the importance of continuous vital sign monitoring for all patients. For example, wearable vital sign monitors were a hot topic of discussion and display. There was considerable discussion of the Nightingale project, a European initiative to develop an effective wireless, wearable, continuous vital sign monitor (e.g., chest patch).
However, despite the enthusiasm for the insights vital sign data can yield, attendees openly agreed on the inaccuracies often present in vital signs, especially respiratory rate. The focus on vital signs also overlooked the importance of truly having early insights into patient deterioration. I was able to share how nursing assessment factors – a unique, proprietary element of PeraHealth’s Rothman Index (RI) – can frequently identify a patient’s functional deterioration before indications appear in vital signs or laboratory data. Reference: Michael J. Rothman, Alan B. Solinger, Steven I. Rothman, G. Duncan Finlay, “Clinical Implications and Validity of Nursing Assessments: A Longitudinal Measure of Patient Condition from Analysis of the Electronic Medical Record,” BMJ Open, 2
With all the interest and excitement around technological improvements in vital sign monitoring – which is admittedly valuable in its own right – the intrinsic shortcomings of focusing too much on vital signs for early warning bear repeating. As I said in the whitepaper:
“RRT calls that are predicated on alerts that are driven by vital signs are problematic. Even in the most sophisticated hospitals with established RRT protocols based on alerts from early warning systems, the warning systems used are typically vital sign-based versions of the Modified Early Warning Score (MEWS) or the National Early Warning Score (NEWS). Almost by definition these systems cannot meet the need of prompting sufficiently early intervention. By the time a patient begins to decompensate and their vital signs change for the worse, the opportunity has been lost for pre-emptive action that might have avoided or minimized the problem. Moreover, these common scores are known to suffer from high rates of false positives leading to alert fatigue and inefficient utilization of RRT resources.”
Furthermore, the fact that the approach we’ve taken really works was on display in a poster I presented reporting on how Houston Methodist used the RI to help reduce mortality and overall acuity. Attendees also appreciated the fact that we’ve successfully built an effective software solution to operationalize our approach to early warning. Indeed, the sophistication and usability of PeraTrend™ as a visualization and delivery platform for proactive intervention was commented on by numerous people.
Instead of waiting for a call from a floor nurse or waiting for vital signs to deviate to the point where a MEWS-type alert is fired, proactive RRTs, like those at Houston Methodist, need truly effective early warning tools such as ours to help them monitor the patient population and guide them to the patients who need closer attention and follow-up.
To hear more about how we are helping to support this proactive approach, join our webinar, “Proactive Rounding Based on Clinical Surveillance: A Team Approach for Rapid Response and Improved Patient Outcomes,” when Carilion Roanoke Memorial Hospital and Penn State Health Milton S. Hershey Medical Center will share innovative approaches for using PeraTrend to integrate proactive rounding with clinical workflows.
September 6, 2018 | 2 p.m. ET.