Clinical Nurse Specialist Mayo Clinic Rochester, Minnesota, United States
Introduction: Introduction/Hypothesis: Optimization and timeliness of intervention intensity for patients displaying early signs of deterioration is important for patient survival and appropriately triaging patients to the intensive care unit (ICU). Successful escalation in care can be actualized with nursing collaboration and utilization of interactive technology. Processes can be developed to assist nurses at the bedside when caring for a deteriorating or complex patient outside of the ICU.
Methods:
Methods: A hospital based, multidisciplinary work team formed to develop practice guidelines and determine safe triage criteria for patients with respiratory deterioration. Internal data were reviewed, focusing on oxygen device escalation, ICU transfers, length of stay, and time to intubation. A multifaceted program, including nursing guidelines, were developed. Interactive technology providing critical care nursing support to general care nurses was implemented. Data were reviewed and care team feedback was collected. Hospital processes were then further defined to streamline triage criteria and promote appropriate intervention escalation pathways outside of the ICU.
Results:
Results: Data were collected for 6 months in 2020. 126 patients utilizing high flow oxygen were reviewed. 211 days were spent in general care that would have previously required an ICU bed, a cost savings of $746,940. Nurses were surveyed to evaluate critical care nursing virtual support. 100% requested to keep this process. Two areas showing greatest improvement included, clear interventions for deterioration (+15%), and nursing concerns taken seriously (+15%). Data were collected for 6 months in 2021. 295 patients were reviewed with data to support escalating respiratory support within general care, adjusting ICU transfer criteria, and expanding admission criteria from the ED to general care. Counterbalance data: zero out-of-ICU intubations and 2 intubations within 1 hour of transfer to the ICU.
Conclusions:
Conclusion: Practice redesign utilizing technology and nursing collaboration can impact outcomes for deteriorating patients in general care. Developing and implementing processes to escalate care safely can be accomplished with appropriate guidelines, monitoring, technology, and virtual nursing collaboration.
