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Code Critical: An Approach Hospitals Shouldn’t Ignore

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Andrea Perry, Emergency Department Clinical Nurse Educator at Sutter Roseville Medical Center, recently interviewed with us about how the medical center’s Emergency Department (ED) created Code Critical, a more targeted response team for critically ill patients, supported by streamlined processes and communication tools.

The interview provides a glimpse of key strategies Andrea shared during a recent webinar, How One Hospital  Drastically Reduced Door-to-Doctor Time by 62%, including how the team reduced:

  • Door-to-doctor time by 62%
  • Onset-to-treatment times for high-acuity cases
  • ED length of stay via improved workflows and communication

To get the full story, you can watch the replay of the webinar at any time here. For more, check out our interview with speaker Andrea Perry below.

What was the biggest factor influencing your decision to move to an automated system for Code Critical at Sutter Roseville Medical Center?

We have been using Everbridge for automated alerts at Sutter Roseville Medical Center for well over 8 years. While we have several medical alerts, our STEMI alerts are paged out through Everbridge. Compared to other alert processes, the automated system has proven to be more reliable. There are fewer people involved in the activation process, decreasing the risk of operator error. Also, the ability to choose the method of alert delivery, helps to ensure that the right people always receive the alert. Through the system you’re able to confirm receipt of the message, unlike other systems such as a telephone page or an overhead alert. In addition to reliability,  we wanted to prevent alarm fatigue. Using the automated system, we are able to send the alert to a targeted group and spare the rest of the hospital’s ears!

Why did you decide to expand the system to better address the sickest patients arriving in the ED? And how did you develop the criteria for this “Code Critical” system?

We call multiple alerts in our emergency department. STEMI, stroke, trauma, and sepsis patients have team responses, expediting the care for those who need it quickly. These alerts allow us to gather our resources with fewer calls than we would otherwise have to make. For patients arriving via ambulance, we can ensure the team is ready to go before the patient even arrives. We started thinking about our other critically ill patients, and how we didn’t have a streamlined approach for them.

For example, the department might receive an ambulance call that a patient was coming in with severe respiratory distress. The nurse would then need to notify several team members by placing a call to the charge nurse, the ED physician, an ED tech, Respiratory Therapy, and laboratory. Also, diagnostic imaging and pharmacy would be uninformed that this patient was of a higher priority, unless the RN notified them if orders needed expediting. Our ED leaders decided this was a disservice to both our critically ill patients and our ED care team. This is how Code Critical was born.

Developing the criteria was a group effort. A work group composed of stakeholders across the hospital observed the various workflows that occurred during the care of critical patients. ED nurses, providers, and techs provided feedback regarding the types of patients they felt could benefit from such an alert. The final criteria provides guidance to the team for activation, but we also recognize that the list cannot be all-inclusive—ED staff are encouraged to activate Code Critical whenever they feel they are necessary.

How did you engage the Emergency Department team about new response team processes and communication tools?

The ED team was engaged from the very beginning! We frequently host week long Kaizen events, a lean method that helps rapidly identify issues and implement process improvements. ED staff including nurses, providers, and techs will volunteer to participate and help develop the process. Involving the team throughout the entire process not only ensures that we have an outcome that will benefit the people at the bedside, it also improves buy-in. As the rest of the team watched their coworkers develop Code Critical, they saw the impact it was having on both the patient and the ED team. We also knew that to keep them engaged, we needed to deliver a product that worked. Therefore, we worked closely with the departments that would be responding to Code Critical to ensure they supported the process, had the resources they needed to be successful, and engaged their staff as well. We did not “go live” until every department was ready. Seeing that the alert was successful from day one helped to keep staff engaged in the process.

Did the Emergency Department encounter any challenges in adopting the new approach?

Not really! The only real challenge we faced was the excitement in the facility and pressure to go live before we felt the process was fully ready. Prior experiments had taught us that, for a process to be successful, it had to be well developed and vetted. Before implementation, we worked as a team to identify areas of improvement and resolve any issues. Other than that, everything flowed smoothly!

What do you attribute the success of the new approach and the 62% improvement in door-to-doctor time to?

I think there are two main reasons why this has been so successful. First, we involved the bedside staff from the very beginning. This allowed us to build engagement throughout the whole process and ensured that the final product made sense to them. Staff involvement and engagement is extremely important to us, and we see the value of it when something like this becomes so successful.

Second, this was something that both nurses and providers advocated for. The nurses wanted more support when caring for critical patients. The providers wanted their sickest patients to receive the same expedited care as trauma patients. The fact that ED staff had already identified a need for a process like this meant that once it was live, they would want to use it; and, once they saw the impact it had on patient care, they would continue to champion the program. We are so glad to have implemented a process that has made such an impact on our team and our ability to provide our patients with excellent care.

Click here to view the full on-demand version of the webinar.