It’s a DOBUTAful Day to Save Lives

Project Topic:

Decreasing rapid response activations and subsequent transfer of care in patients with heart failure

Hospital, City and State:

Methodist Hospital, San Antonio, Texas

Unit:

Cardiac Progressive Care Unit (CPCU)

CSI Participants:

• Sevanah Garces, BSN, RN, CNC
• Devin Kelley, BSN, RN
• Anthony Ramiro, DNM, MAN, RN

Project Goals/Objectives:

1. Decreased rate of RRT activation in the unit 60%
2. Decreased rate of ICU transfers 50%
3. Improved unit Healthy Work Environment Assessment Tool (HWEAT) scores on True Collaboration and Skilled Communication results at 4.0 respectively

Project Outcomes:

1. Decreased rate of RRT activation in the unit 19%
2. Decreased rate of ICU transfers 25%
3. Improved unit HWEAT score on True Collaboration from 2.96 to 4.44
4. Improved unit HWEAT score on Skilled Communication from 3.18 to 4.49
5. Improved all HWEAT standard and aggregate scores
6. Return on investment 2138%

Project Overview:

The CPCU cares for patients with heart failure with a New York Heart Association (NYHA) classification of III or IV on intravenous inotropic support. These patients exhibit a high risk of sudden cardiac death due to a reduced ejection fraction. Increases in Rapid Response Team (RRT) activations and subsequent transfers to the intensive care unit (ICU) had been noted. Our project aimed to identify early identification of clinical decompensation for patients with heart failure and collaborate with nursing staff and providers to implement interventions to reduce the rate of RRT activations.

We implemented safe medication practices for patients on torsemide with education for staff and patients on the use and side effects to watch for. An early alert tool was created based on the patients' vital signs and cardiac output. Based on the numbers, patients’ risk of decompensation was evaluated as low, medium, high, or urgent. Each level of alert had defined measures and interventions too complete. This alert tool was a collaborative effort with consensus from nursing and the Heart Failure provider team.

Using the early alert tool and educating new and experienced staff on the new standard, our project was able to decrease RRT activations 19% (53 to 43) and transfers to the ICU 25% (24-18). The fiscal impact of this reduction is calculated to be a projected annual savings of $160,656. With the collaborative nature of our project, we also experienced an increase in the health of the work environment through the HWEAT, with aggregate and all six standard scores increasing.