The Health Roundtable Early detection of patient deteriopration Presenter: (delegate name) Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct c_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 commenced 3

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 5

The Health Roundtable Number of charts audited Correct Frequency of Observations Accuracy of Observations Escalation of Deterioration (MEWS >4) TPCH51593%77%88% Wards (compiled in order of Accuracy of Observations) % no identified MEWS > % %90%no identified MEWS > %90%no identified MEWS > %88%no identified MEWS >4 6850%88%no identified MEWS > %87%86% %80%0% %80%no identified MEWS > %80%no identified MEWS > %77%100% %75%no identified MEWS > %70%100% %70%no identified MEWS > %63%100% %61%no identified MEWS > %61%80% %40%no identified MEWS >4 19NARR 20NARR 21NARR Monthly report to NUMs and S&Q Committee 6

The Health Roundtable Number of Arrest & MET calls ( ) MET/MEWS introduced 7

The Health Roundtable Inpatient Arrest Calls /1000 separations (2009 – 2012) MET/MEWS introduced In 2010: 55% of cardiac arrest calls had a confirmed cardiac arrest 46% of patients with confirmed cardiac arrest survived to discharge 8

The Health Roundtable Inpatient MET Calls /1000 separations ( ) MET/MEWS introduced Average 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;13:313 9

The Health Roundtable Number of ICU Admissions post Arrest/MET Call ( ) MET/MEWS introduced 10

The Health Roundtable Length of ICU Stay (hrs) post Arrest/MET call ( ) MET/MEWS introduced

The Health Roundtable Hospital Standardised Mortality Rate (2007 – 2011) MET/MEWS introduced 12

The Health Roundtable Mortality Rate / 1000 separations (2008 – 2012) (excluding Palliative Care Unit) MET/MEWS introduced 13

The Health Roundtable SUMMARY The simultaneous introduction of MEWS and MET resulted in:  A low “dose” of MET calls  Patents transfers to ICU post arrest/MET call Reduced in 2 nd year of implementation Progressive reduction in LOS (40%)  Improvement in hospital mortality Underpinning this result:  Compliance with observations and MEWS  Early escalation when deterioration occurs  Rapid medical review by the home team 14

The Health Roundtable Patient safety culture survey April

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