Assessing Adherence to Enhanced Early Warning Score Assessment on the Transplant Unit

Abstract

Problem & Purpose: Patients show subtle changes six to eight hours before clinical deterioration. There was an underutilization of the hospital’s enhanced early warning score (Rapid Evaluation for Safer Care Utilizing Machine Learning and Escalation-RESCUE) in the adult transplant unit in a quaternary care center. This quality improvement initiative aimed to optimize the use of RESCUE through integration into the nurse’s electronic health record (EHR) and report sheets and implementation of a six-hour reassessment with a bedside huddle for critical scores. Methods: Over 15 weeks, bedside nurses reviewed the patient’s RESCUE score during change of shift handoff. This project was expected to affect approximately 45 nurses and 27 patients daily. An updated report sheet to include RESCUE was implemented for 100% of patients. 100% of charge nurses and 90% of the nurses on the unit had RESCUE added to their EHR. Each shift, the charge nurse completed a Research Electronic Data Capture (REDCap) survey to identify if nurses updated the RESCUE score on their handoff sheet. Nurses rechecked the score six hours into their shift and completed the nursing portion of the RESCUE algorithm. The nurse completed a REDCap survey stating their patient’s RESCUE score and huddle interventions. Results: The transplant staff did not use the RESCUE score before implementation. During the implementation phase, there was a 10.5% (n= 551) median compliance rate in RESCUE reassessment compliance. There was an 18% (n= 57) median compliance rate with updating the patient's report sheet. 17 bedside huddles were completed for patients meeting criteria based on the hospital’s algorithm. Conclusions: RESCUE utilization has increased compared to baseline data. Barriers to implementation included staffing shortages and high utilization of agency and float pool nurses. Facilitators of implementation included institutions, management, and charge nurses’ buy-in to the practice change.