New Patient Deterioration Index

By George Scott, MD, PhD, ACMIO Intermountain Health Peaks Region

Patients can experience physiologic deterioration up to 5 percent during their hospital stay, resulting in admission to the ICU or death. Medical Emergency and Rapid Response Teams were developed to rapidly assess and treat patients of concern to prevent a cardiopulmonary arrest. Delayed MET/RRT calls are common. The ability to identify these patients and intervene is key since patients whom are attended to within 30 to 60 minutes of onset of PD have significantly lower mortality rates.

The Epic Patient Deterioration Index was developed to identify and predict a patient’s risk of clinical deterioration earlier and allow care teams to assess and intervene sooner. The Patient Deterioration score is incorporated into Epic nursing clinical workflows. As clinical data are documented on a patient, the Deterioration model will calculate a score and store it in Epic every 15 minutes. A Best Practice Advisory will fire in the chart when a Deterioration Index score reaches or exceeds the threshold limit for a patient that is not excluded from monitoring. The nurse should assess the patient for any signs of deterioration at this time and complete the appropriate interventions, such as calling the physician or the RRT.

This new tool will be rolled out across the organization, with an early roll out at Saint Joseph in the Med/Surg areas prior to region-wide implementation. This will not change the physician workflows for these patients, but all need to be aware of this enhancement and the identification of these patients. Nurses might contact physicians with notification their patient has a Deterioration alert. They might also describe the contributing factors for the deterioration.

Physicians with questions about this new tool can contact Saint Joseph CMO John Tynes, MD, MBA.