ABSTRACT
SESSION TITLE: Lifelong Learning in Critical Care SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Physiological instability occurs several hours prior to in-hospital cardiac arrest. Delays in early intervention is associated with an increase in morbidity, mortality and the incidence of in-hospital cardiac arrest [1]. Improving health care quality through the deployment of a rapid response team was recommended in 2004 by the Institute for Healthcare Improvement through the ‘100,000 Lives Campaign’ [2]. METHODS: Cleveland Clinic Fairview Hospital, one of the largest academic centers of the Cleveland Clinic Health Care System, appointed a dedicated daytime Rapid Response Registered Nurse in 2016, and in 2017 the above coverage was expanded to the night and week-end shifts. In 2019 a dedicated Internal Medicine Residents team took the lead of the Rapid Response and Code Blue team. Starting in 2017 monthly unannounced Rapid Response and Code Blue educational simulation cases were implemented, and in 2020 a dedicated simulation Lab provided immersive leaning experience to healthcare practitioners. In 2018 a centralized Code Blue event ion by the Quality Data Registry begun and in 2020 monthly events review helped improve the quality of cardiopulmonary resuscitation with valuable feedback provided to caregivers. Also, in 2020 the Cleveland Clinic Health Care System Resuscitation Operations Council was formed, where representatives from each hospital shared experience and quality initiatives. The above helped with the standardization of care across the 21 hospitals of the Cleveland Clinic Enterprise. RESULTS: Across five years of quality initiatives and consolidation of our rapid response response team from 2016 to 2021, the number of Rapid Responses increased by 104 % from 704 events in 2015 to 1438 in 2021. At the same time, the number of Code Blue events decreased by 56.5% from 283 in 2015 to 123 in 2021 and the number on non-critical care medical and surgical units decreased by 48.9% from 45 to 23 cases per year. The above was seen despite a significant increase in the hospital patient census, and the Coronavirus Infectious Disease 19 Pandemic where Fairview Hospital served as a tertiary referral center for all North Central and North Western Ohio. These results confirm prior published data on the subject where not only a focused rapid response team but also educational, simulation and case review activities are all associated with a reduced incidence of unexpected cardiac arrest [3-9]. CONCLUSIONS: A dedicated Rapid Response and Code Blue team, Simulation in education, and frequent quality review of cardiac arrest cases are all strategies that reduce the incidence of in hospital cardiac arrest. Future research is needed to highlight the impact of each of those quality and educational initiatives on outcomes and performance. CLINICAL IMPLICATIONS: Educational Activities, Dedicated Rapid Response Team and Quality Case Reviews decreases the incidence of In-Hospital Cardiac Arrest. DISCLOSURES: No relevant relationships by Francois Abi Fadel No relevant relationships by Lauren Crosby no disclosure on file for Megan Edwards;no disclosure on file for June McMahan;no disclosure on file for Patrick Murphy;No relevant relationships by Kelly Orlosky No relevant relationships by Anoosha Tauquir
ABSTRACT
RATIONALE: The Center for Medicare and Medicaid requires hospitals to report compliance with a sepsis treatment bundle as part of its Inpatient Quality Reporting Program. Cleveland Clinic Foundation (CCF) Fairview hospital reported a Sepsis Core Measure Compliance (SEP-1) of 25% and a mortality averaging 20% in 2017. Both were very dismaying. METHODS: Starting in 2018 a sepsis committee was convened with a plan for several quality initiatives. Real-time audits and peer to peer education were provided to caregivers on the failed cases. A sepsis alert in the Electronic medical record system and a sepsis checklist were initiated. In 2020 a Code sepsis team was created with 24 hours response and follow-up on all sepsis alerts. As the CCF enterprise decided in 2020 to focus on mortality reviews, our hospital adopted rather a hybrid model reviewing all failed compliance cases of the one hour antibiotic in addition to mortality cases reviews. Several educational and awareness sessions were entertained with the residents, advanced practice providers, hospitalists, intensivists and nursing teams. Seventy Registered Nurses received training in 2018 and forty-three in 2021. Sepsis Champions were designated encompassing all stakeholders. Collaboration with Emergency Room caregivers to provide hand-off communication on sepsis alert patients to the medical-surgical providers ensured continuity of care. A sepsis order set was revised and went live in September 2021. Beginning of 2022, A dedicated full time quality coordinator and program manager for sepsis was appointed. RESULTS: Despite the Coronavirus 19 infection (COVID 19) pandemic where Cleveland Clinic Fairview Hospital was designated as the tertiary referral academic center for northwestern Ohio and despite the inclusion of COVID 19 mortality within the sepsis mortality data, comparing 2017 to 2021, SEP-1 measures compliance improved from 25% to 60.4% and sepsis mortality decreased from 20% to 15.38%. The one hour antibiotic compliance averaged 78.89% in 2021. With the above performance and impact on survival, Cleveland Clinic Fairview Hospital was leading the CCF Hospitals both in compliance and Mortality. Several of the above Fairview hospital quality initiatives and approaches were later adopted across the Cleveland Clinic Hospitals. CONCLUSION: A sepsis dedicated committee, quality/program manager and a code sepsis team with a focus on the evidence base components of the sepsis core measures, all helped improve compliance and decrease mortality. Future research is needed to highlight the impact of each of those quality and educational initiatives on outcomes and performance. Word Count: 400 (Figure Presented).