View
216
Download
0
Category
Preview:
Citation preview
The Health Roundtable
Early detection of patient deteriopration
Presenter: (delegate name)
Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012
13-3c_HRT1215-Session_WARD_TPCH_QLD
The Health Roundtable
KEY PROBLEM
Patient harm due to lack of recognition and appropriate management of the deteriorating patient was repeatedly identified in:
Root Cause Analysis for serious adverse events
Clinical Incident reviews
Review of patients after cardiac arrest or inpatient transfer to ICU 2
The Health Roundtable
KEY CHANGES IMPLEMENTED
Multidisciplinary working party developed:
Standardised minimum observations General Observation Chart incorporating Modified
Early Warning Score (MEWS) Escalation protocol using MEWS score to trigger
review by clinical team ISBAR communication tool Medical Emergency Team (MET) criteria and
participants Education of Medical and Nursing staff (COMPASS –
ACT Health)
December 2009 MET and MEWS commenced3
The Health Roundtable
COMPASS OBSERVATION CHART
adapted for TPCH
Note: pain score, bowels, weight on page 2
4
The Health Roundtable
Ward audit – 10 charts
Episodes of Deterioration and Appropriate Escalation
-1
0
1
2
3
4
5
6
20
-De
c-1
1
13
-Ma
r-1
2
08
-Ap
r-1
2
23
-Ma
y-1
2
18
-Ju
n-1
2
08
-Au
g-1
2
Audit Date
Nu
mb
er
Episodes ofDeterioration
Episodes ofDeteriorationwithAppropriateEscalations
Charts with Observations Correct
0.67CL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
03
-Au
g-1
01
4-S
ep
-10
02
-Ja
n-1
12
0-J
an
-11
08
-Fe
b-1
10
4-M
ar-
11
04
-Ap
r-1
12
6-A
pr-
11
26
-Ma
y-1
12
6-J
un
-11
14
-Ju
l-1
12
6-J
ul-
11
23
-Au
g-1
11
9-S
ep
-11
24
-Oct-
11
09
-No
v-1
12
0-D
ec-1
10
7-F
eb
-12
13
-Ma
r-1
20
4-A
pr-
12
08
-Ap
r-1
21
9-A
pr-
12
23
-Ma
y-1
20
8-J
un
-12
18
-Ju
n-1
21
7-J
ul-
12
08
-Au
g-1
22
8-A
ug
-12
00
-Ja
n-0
00
0-J
an
-00
00
-Ja
n-0
00
0-J
an
-00
00
-Ja
n-0
00
0-J
an
-00
00
-Ja
n-0
00
0-J
an
-00
00
-Ja
n-0
0
Audit Date
Pro
po
rtio
n o
f C
ha
rts
Au
dit
ed
wit
h a
ll
Ob
s C
orr
ec
t
5
The Health Roundtable
Number of charts audited
Correct Frequency of Observations
Accuracy of ObservationsEscalation of Deterioration
(MEWS >4)
TPCH 515 93% 77% 88%
Wards (compiled in order of Accuracy of Observations)
1 10 100% 100% no identified MEWS >4
2 10 100% 100% 100%
3 10 100% 90% no identified MEWS >4
4 30 97% 90% no identified MEWS >4
5 40 100% 88% no identified MEWS >4
6 8 50% 88% no identified MEWS >4
7 47 98% 87% 86%
8 20 100% 80% 0%
9 40 100% 80% no identified MEWS >4
10 50 98% 80% no identified MEWS >4
11 30 90% 77% 100%
12 40 68% 75% no identified MEWS >4
13 40 88% 70% 100%
14 20 100% 70% no identified MEWS >4
15 40 100% 63% 100%
16 28 93% 61% no identified MEWS >4
17 38 92% 61% 80%
18 10 100% 40% no identified MEWS >4
19 NARR
20 NARR
21 NARR
Monthly report to NUMs and S&Q Committee
6
The Health Roundtable
Number of Arrest & MET calls(2009 - 2011)
MET/MEWSintroduced
7
The Health Roundtable
Inpatient Arrest Calls /1000 separations (2009 – 2012)
MET/MEWSintroduced4.7
3.8
2.9
In 2010:55% of cardiac arrest calls had a confirmed cardiac arrest46% of patients with confirmed cardiac arrest survived to discharge
8
The Health Roundtable
Inpatient MET Calls /1000 separations (2009 -2012)
MET/MEWSintroduced
Average 8.52011 Average 9.1
*Target 26-56/1000seps
* Source: Effectiveness of the Medical Emergency Team: The Importance of Dose. D Jones et. al. Critical Care 2009;13:3139
The Health Roundtable
Hospital Standardised Mortality Rate (2007 – 2011)
MET/MEWSintroduced
12
The Health Roundtable
Mortality Rate / 1000 separations (2008 – 2012) (excluding Palliative Care Unit)
MET/MEWSintroduced
13
The Health Roundtable
SUMMARYThe simultaneous introduction of MEWS and MET resulted in: A low “dose” of MET callsPatents transfers to ICU post arrest/MET call
Reduced in 2nd year of implementation Progressive reduction in LOS (40%)
Improvement in hospital mortality
Underpinning this result: Compliance with observations and MEWSEarly escalation when deterioration occursRapid medical review by the home team
14
The Health Roundtable
I feel Confident in escalating concerns when a patient deteriorates
1 410
72
178
0
20
40
60
80
100
120
140
160
180
200
DisagreeStrongly
Disagree Slightly Neutral Agree Slightly Agree Strongly
No.
res
pons
es
Patient safety culture survey April 2012
15
The Health Roundtable
LESSONS LEARNT
Multidisciplinary team to develop system Education must be ongoing Audit of accuracy of observations and escaltion
necessary Feedback to staff re results essential
16
Recommended