ICU Transfers Decrease with Communication Bundle

Early-warning score system plus communication protocol prevents patient deterioration

After implementing a new communication bundle, Southern New Hampshire Medical Center saw both a significant decline in unplanned transfers of medical-surgical patients to the intensive care unit and ICU admissions of patients after a rapid response team call, a pilot study reports.

The 189-bed, Magnet-designated community hospital in Nashua, New Hampshire embedded a seven-item modified early-warning score system into the electronic medical record for patients in its four medical-surgical units and its ICU.

• The EWS scale ranged from zero to 21.
• Scores above four automatically generated a red exclamation point by the patient’s name on the EMR
• The exclamation point was visible to the nurse and unit secretary

As part of the communication bundle, the score also triggered an electronic page to an experienced critical care nurse preassigned to respond to rapid response team calls.

After receiving the page, the ICU nurse:

• Reviewed the patient’s EMR
• Consulted with the patient’s nurse to discuss the score and develop a plan

The EWS also triggered a reassessment of at least one item on the EWS scale by the patient’s nurse. The combination of the consultation and the reassessment may initiate other actions, such as:

• Notifying a provider
• Administering as-needed medications
• Following established protocols for interventions.

“The early-warning score helps identify patients with clinical signs of deterioration, but that information must be quickly communicated to a nurse with an appreciation for the urgency of the situation and the knowledge to take action,” says primary investigator Cheryl Gagne, RN, DNP, CNEA, chief nursing officer at the hospital. “Our communication bundle may have led to earlier and more effective interventions by medical-surgical nurses, facilitated by collaboration with experienced critical care nurses.”

During the study period:

• ICU admissions of patients after RRT calls declined significantly
• ICU admissions of patients with an EWS greater than four declined significantly
• Response time to the EWS alert on the EMR decreased
• RRT calls for patients with EWS greater than four declined

This suggests patients with patients with deteriorating conditions were identified early because the bundle prompted intervention before a patient’s score increased.

“Our communication bundle may have led to earlier and more effective interventions by medical-surgical nurses, facilitated by collaboration with experienced critical care nurses,” Gagne says.

The initial results from the hospital’s pilot study are published in the May 2018 issue of American Journal of Critical Care.