1. The Health Roundtable Early detection of patient deteriopration Presenter: (delegate name) Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1 3-3c_HRT1215-Session_WARD_TPCH_QLD

2. 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

3. 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

4. The Health Roundtable COMPASS OBSERVATION CHART adapted for TPCH Note: pain score, bowels, weight on page 2 4

5. The Health Roundtable Ward audit – 10 charts 5

6. 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) 110100% no identified MEWS >4 210100% 310100%90%no identified MEWS >4 43097%90%no identified MEWS >4 540100%88%no identified MEWS >4 6850%88%no identified MEWS >4 74798%87%86% 820100%80%0% 940100%80%no identified MEWS >4 105098%80%no identified MEWS >4 113090%77%100% 124068%75%no identified MEWS >4 134088%70%100% 1420100%70%no identified MEWS >4 1540100%63%100% 162893%61%no identified MEWS >4 173892%61%80% 1810100%40%no identified MEWS >4 19NARR 20NARR 21NARR Monthly report to NUMs and S&Q Committee 6

7. The Health Roundtable Number of Arrest & MET calls (2009 - 2011) MET/MEWS introduced 7

8. The Health Roundtable Inpatient Arrest Calls /1000 separations (2009 – 2012) MET/MEWS introduced 4.7 3.8 2.9 In 2010: 55% of cardiac arrest calls had a confirmed cardiac arrest 46% of patients with confirmed cardiac arrest survived to discharge 8

9. The Health Roundtable Inpatient MET Calls /1000 separations (2009 -2012) MET/MEWS introduced Average 8.5 2011 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

10. The Health Roundtable Number of ICU Admissions post Arrest/MET Call (2009-2011 ) MET/MEWS introduced 10

11. The Health Roundtable Length of ICU Stay (hrs) post Arrest/MET call (2009-2011) MET/MEWS introduced 140.0 88.5 81.8 11

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

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

14. 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

15. The Health Roundtable Patient safety culture survey April 2012 15

16. 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