CSI Project

Use the Clues, Follow the MEWS

Ochsner Medical Center–Baton Rouge (Baton Rouge, Louisiana)

CSI Summary

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Summary

CSI Presentation

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Presentation

CSI Toolkit

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Toolkit

Added to Collection

Project Topic

Instituting an ICU Nurse Consultation (INC) program and utilizing the Modified Early Warning System (MEWS)

Hospital Units

Intensive Care Unit (ICU)
Medical-Surgical Unit
Telemetry Unit

CSI Participants

Amanda Lennon, BSN, RN
Connie Miller, BSN, RN, CCRN
Paige Screen, ASN, RN
Barbara Van Lieu, BSN, RN, WCC

Project Goals/Objectives

  1. To adopt an INC program on inpatient units of facility
  2. To decrease ICU admissions following a rapid response team (RRT) call 8 percent
  3. To improve accuracy of MEWS Best Practice Advisory documentation in reviewed patients 80 percent
  4. To decrease unplanned transfers to ICU 5 percent
  5. To decrease in-house cardiac arrests (IHCAs) outside of ICU 20 percent
  6. To decrease missed rapid responses rate 50 percent

Project Outcomes

  1. Adopted INC program throughout facility and achieved education of 100% of responding ICU nurses and 75% of floor staff nurses
  2. Decreased ICU admission following RRT call 61.3%
  3. Decreased unplanned transfers to ICU 26.8%
  4. Decreased IHCAs outside of ICU 32.2%
  5. Decreased IHCAs in ICU 44.3%
  6. These outcomes resulted in an estimated annual fiscal impact of $189,652.

Project Overview

For the last several years, our ICU has seen an increase in the number of rapid response calls throughout the facility. Even with the use of the electronic medical record to alert floor nurses to a patient’s deterioration using the MEWS system, many of these patients were not receiving interventions and continued to decline ― warranting transfer to ICU. A small number of these patients experience IHCAs outside of the ICU prior to transfer. Our CSI team decided to investigate how the use of the existing MEWS system built into our EHR could help identify these at-risk patients.

After researching the topic, we created a system in which the floor nurse could call an ICU nurse to the bedside to assess a patient and make suggestions about next steps. We sent out a pre-implementation survey, which confirmed the need for such a program. We then educated the ICU and floor staff about this process and completed chart reviews on every patient with a MEWS of four or above.

By the end of the project, we saw decreases in the number of transfers to ICU post-rapid response call, unexpected transfers to ICU, and IHCAs both in and outside of the ICU. We also saw improvement in the documentation when responding to the EHR Best Practice Advisories.

Our project was originally targeted to Medical-Surgical and Telemetry staff, with plans to implement facility-wide. Scaling the project will require additional training and yearly follow-up for new staff. The program has been added to our annual skills fair education day.

Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

Disclaimer
The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.