Improving Early Detection Of Patient Deterioration Through Effective Decision-Making

Project Topic:

Improving early detection of patient deterioration

Hospital, City and State:

Ochsner Medical Center, New Orleans, Louisiana

Unit:

• Rapid Response

CSI Participants:

• Nicholas Hill, ADN, RN, CCRN
• Matt Duck, BSN, RN, CCRN
• Katherine Michael, BSN, RN, CEN
• Mollie Wagner, BSN, RN, CCRN
• Coach: Kala Gaudet, BSN, RN, CCN

Project Goals/Objectives:

1. Increase proactive rounds (PR) 15%
2. Reduce rapid responses 10%
3. Decrease unplanned transfers 5%
4. To remain equal or less than 1 code per week or 52 codes per year.
5. Improve Healthy Work Environment Assessment Tool (HWEAT) aggregate score from 3.79 to 4.5
6. Increase HWEAT Effective Decision-Making from 5.22 to 5.3

Project Outcomes:

1. Increased proactive rounds 5% (67% → 70.5%)
2. Decreased rapid responses 35% (13.5% → 8.8%)
3. Decreased unplanned ICU transfers 10% (13.7% → 12.3%)
4. Decreased cardio-pulmonary arrests/codes 25% (0.67% → 0.50%)
5. HWEAT2 aggregate score for Rapids decreased from 4.95 to 4.67
6. HWEAT Effective Decision-Making scores for Rapids increased from 5.22 to 5.3

Project Overview:

This project focused on improving patient safety and clinical outcomes by reducing preventable deaths and unplanned ICU transfers on a high-risk unit with frequent rapid response activations. The initiative combined staff education, technology integration, and enhanced clinical surveillance to strengthen early recognition of patient deterioration. Education was provided to multidisciplinary teams, including MTSU staff, Rapid Response teams, and the Ochsner Virtual ICU (OvICU), ensuring a shared understanding of escalation protocols and early warning indicators. Unit champions were selected to serve as on-the-ground resources, reinforcing best practices and supporting adoption. A structured data collection process was developed to track outcomes and guide ongoing improvements, while a feedback loop enabled continuous communication and refinement of interventions.

A key component of the project was the implementation and evaluation of new patient monitoring technology alongside the introduction of the National Early Warning Score (NEWS) system. While the initial device deployed did not fully meet operational needs, the broader framework—including staff education, virtual ICU collaboration, and standardized early warning scoring—contributed to measurable progress toward the project’s goals. The OvICU partnership enhanced care coordination, providing real-time surveillance, comparison of patient vital signs with electronic monitoring platforms, and additional clinical oversight. This virtual nursing model helped identify subtle clinical changes earlier and supported timely interventions. Despite delays in introducing a second device later in the project, the combined efforts of education, standardized assessment tools, and virtual support created meaningful improvements and established a strong foundation for continued innovation and patient safety enhancement.