Nurse-Driven Improvement: Proactive Rounding Benefits At-Risk Patients and Nurses
From left, Lindsay Osgood, Karen Reilly, Megan Matson and Alli Bell
This project was presented during a breakout session at Karsh Scholars Day on May 26, 2022.
By implementing a process for STAT nurses to proactively round on intermediate care units, a group of nurses and nurse leaders was able to improve patient outcomes and enhance communication among care providers.
“We wanted to proactively identify patients at risk for decompensation,” said Alli Bell, MSN, RN, ANP-BC, professional development manager for the Float Pool. “Our hope is that we would then be able to intervene, prevent unexpected ICU admissions and impact the patient’s overall outcome.”
In intermediate care units, a rapid response or Code Blue is typically called when a patient is decompensating, followed by an assessment from the STAT team nurses. For this project, the team trialed an early-warning tool available within Epic. The team set parameters to identify at-risk patients, and STAT nurses began proactively rounding on intermediate care units to assess these patients and speak with staff.
“The STAT nurses would also check in with the charge nurse to see if there were other patients whom staff were concerned about,” said Lindsay Osgood, BSN, RN, STAT nurse. “We found that, many times, the patients who were identified by the tool weren’t actually the patients that nurses were most concerned about.”
In these cases, a patient’s labs and vitals may have been normal, but the nurses noticed a change in the patient.
“Nurses know early that something just isn’t right,” said Osgood.
Osgood and her colleagues on the STAT team used the opportunity to encourage nurses on the units to trust their instincts and feel confident initiating a rapid response. “If you think you might need to call a rapid response, go with your gut and bring the resources to the bedside,” she said. “It’s better to have that support.”
The team found that the early warning tool was not optimal because it only captured about 30 percent of patients who decompensated. However, the proactive rounding was found to benefit staff and patients alike.
Jeanie Gnall, MSN, RN, of Braunwald Tower 16AB, shared that she felt supported by the STAT nurses with proactive rounds. “Having more familiarity with the STAT nurses and feeling more comfortable calling on them to help really has benefited patients,” she said.
Additionally, during the trial, hospital mortality and cardiac arrests decreased on inpatient intermediate care units, and rapid response calls increased. STAT nurses and physicians also reported that increased communication benefited patients and enhanced collaboration during critical events.
“The STAT nurses felt that they were able to identify patients who had the potential for decompensating sooner and could intervene with the proactive rounding approach,” said Megan Matson, DNP, RN, CCRN-K, CENP, assistant nursing director for the Thoracic Intermediate Care Unit and Thoracic Surgery ICU.
As a result, STAT nurses continue to round proactively on all intermediate care units.
The project team included Alli Bell, MSN, RN, ANP-BC, nursing director of the Float Pool; Megan Matson, DNP, RN, CCRN-K, CENP, professional development manager; Karen Reilly, DNP, RN, NEA-BC, associate chief nurse; Karen Griswold, BSN, RN, MBA, CPPS, of Patient Safety; Lindsay Osgood, BSN, RN, STAT nurse; and Crystal West, MSN, RN.