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Southern New Hampshire Medical Center

Southern New Hampshire Medical Center initiates electronic early warning system to reduce ICU admissions

Using an Early Warning System, the 188-bed acute care facility reduced its unplanned ICU admissions by 20.4 percent in two years – potentially saving thousands of dollars in transfer-related costs.

‘An ounce of prevention is worth a pound of cure,’ goes the saying. Nashua-based Southern New Hampshire Medical Center (SNHMC) applied prevention to a digital scale – the impact of which, both clinically and financially, is substantial.

Together with nursing leadership, the informatics leadership team at SNHMC spearheaded the creation of an early warning system (EWS) to cut admissions to its 11-bed intensive care unit (ICU).

Embedded within the hospital’s Cerner Soarian® Clinicals system, the EWS is a workflow management capability. It measures and calculates an early warning score using physiologic parameters such as respiratory rate, heart rate and blood pressure.

“We recognized that an electrically programmed early warning score could be used to promote early recognition of patient deterioration and initiate early interventions with the goal of avoiding the need for unplanned transfers to the ICU,” said Cheryl Gagne RN DNP, associate vice president, clinical informatics, SNHMC.

“When a score of three or higher is reached, the workflow notifies the patient’s nurse. The alert directs the nurse to complete an early warning score evaluation, so that the most up-to-date data can be used to determine the current score,” says Gagne. “Any score of five or greater triggers a call to the Rapid Response Team (RRT) nurse who then consults with the patient’s nurse.”

In just two years, the EWS and associated workflow reduced unplanned ICU admissions by 20.4 percent.

“In addition,” said Gagne, “transfers to the ICU of patients exhibiting serious deterioration and requiring a call to the RRT decreased by 52 percent in the same period.”

Nurses, clinicians and IT professionals worked together to define the requirement, conceive an improved process, design the solution, drive development and promote its adoption. The data-driven process improvement methodology known as DMAIC – define, measure, analyze, improve and control – helped guide and unite the team.

“When taking into consideration the average cost per day of an ICU stay, which are estimated to range between $2,500 to $4,000, reducing unplanned transfers has the potential to help save lives and hospital expenses,” according to Gagne.

With these possibilities in mind, consider the impact of technology-enabled prevention across the industry. Who is next to hop on the scale?

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.