Virginia Commonwealth University Medical Center has designed a process that combines clinical expertise with technology to detect subtle changes in patients’ conditions and alerts the hospital’s Rapid Response Team to intervene in real time before the patients get any worse.

The Early Warning System is embedded in in the medical center’s electronic health record and uses real time clinical data to identify patients who might need additional interventions.

The computer program pulls data including vital signs, lab values, and other clinical information from the electronic records of patients and calculates an Early Warning score for each patient. The scores show up on a dashboard that ranks patients according to how sick they are.

“When we analyzed safety opportunities and areas where we could make improvement, we decided to leverage our technology to provide better care for our patients. A computer can detect subtle deterioration in patients based on clinical data before it becomes obvious to a clinician,” says Dale Harvey, MS, RN, director of performance improvement.

For instance, patients who have infections are at risk for developing sepsis when the infection spreads throughout their body. “These patients may have a slow, subtle increase in heart rate, a decrease in blood pressure, and other subtle changes in vital signs. The system can pick these up much quicker than the human brain can and we can intervene before the condition worsens,” she says.

Rapid Response

The hospital has a Rapid Response Team of clinicians on duty 24 hours a day, seven days a week. Their job is to respond to calls by other team members and clinicians who need assistance at the bedside. They also respond to calls from patients or family members. “The team sometimes provides nothing more than a second assessment, but they also can provide expert critical care and another set of hands if the patient is critical,” she says.

The system alerts the hospital’s Rapid Response Team to triage and visit the most critically ill patients before they get a call from a doctor or a nurse that the patient is in distress, she says.

“The Early Warning system gives the Rapid Response team a guide to proactively go out and work with patients. When the team is not being called, the Rapid Response Team nurses use the Early Warning scores as a guide to seeing patients who might need interventions the most,” Harvey says.

The case management department is adapting the Early Warning approach of using data to guide human interactions, says Ryan Raisig, MHA, director of care coordination.

The department is building a tool into the medical record that will analyze patient data for risk of mortality or readmission after discharge. “This tool will help us most effectively allocate resources. We will be able to use the patient score to identify at-risk patients early in the stay and take steps to ensure a safe transition,” he says.