To address a well-documented hospital adverse outcome (in-hospital patient clinical deterioration), Kaiser Permanente Northern California (KPNC) developed and implemented the Advance Alert Monitor (AAM) program. Using predictive analytics, the team developed a model to alert clinicians up to 12 hours prior to a patient’s likely deterioration. This early detection allowed clinicians to devise and implement a care plan to prevent deterioration of the patient’s condition and/or align the care plan with the goals of the patient.

A multidisciplinary team developed the AAM program to identify and respond to alerts of likely patient deterioration. Clinical and technology teams worked collaboratively to develop and finalize the evidence-based criteria to generate an AAM score and trigger an alert as appropriate. Once the algorithm was developed and integrated into the electronic health record (EHR), a team of virtual quality nurse consultants were trained to monitor the alerts and to follow a response protocol. This protocol includes an initial review of the patient’s chart and corresponding follow-up with the Rapid Response Team (RRT) nurse as needed. The RRT nurse is then responsible for following up with the bedside clinical team to determine next steps.

Key results from implementation of the AAM program include lower mortality within 30 days of an alert, reduction of intensive care unit (ICU) admissions, decreased hospital length of stay, lower 30-day mortality after admission, and higher proportion of patients with favorable status (alive, not in the hospital, not rehospitalized) within 30 days after an alert.¹ The program produced favorable changes to align hospital care with patient preferences. Implementation of this innovation resulted in improved patient safety and quality for patients at high risk of clinical deterioration.

The innovation uses an early detection alert system to identify patients who are high risk for clinical deterioration in medical, surgical, and telemetry units so that appropriate actions can be taken by the clinical care team, such as transfer to an ICU, to prevent further worsening of the patient’s condition or mortality.

To implement the AAM program, organizations should consider the following action steps:

• Convene a multidisciplinary team of clinicians to review and use evidence-based criteria to develop the algorithm to determine the AAM score, which is used to determine likely patient clinical deterioration.
• Work with the information technology team to integrate the program into the organization’s EHR.
• Identify the team members who will be trained to monitor and review the AAM scores and facilitate the triage process as appropriate. Kaiser Permanente Northern California (KPNC) used virtual quality nurse consultants for this task.
• Work closely with the RRT and clinicians to determine the best workflow for triage and follow-up.
• Review the data regularly to identify opportunities to improve the process and the outcomes and refine the AAM algorithm as needed.

The AAM program has been implemented in 21 hospitals within the KPNC system. Several healthcare organizations have contacted KPNC about implementing the AAM program or something similar.

Seeking a sustainable process to enhance their hospitals’ response to sepsis, a multidisciplinary team at WellSpan Health oversaw the development and implementation of a system that uses customized electronic health record (EHR) alert settings and a team of remote nurses to help frontline staff identify and respond to patients showing signs of sepsis. When the remote nurses, or Central Alerts Team (CAT), receive an alert, they assess the patient’s information and collaborate with the clinical care team to recommend a response. When indicated, the clinical team implements elements of the evidence-based sepsis bundle.

Piloted in six of the eight health system’s hospitals, the initiative was associated with increased compliance with sepsis bundles and a decrease in hospital mortality in a little over two years. The team found that having a remote monitoring team is a more efficient use of staff and expertise. This benefit became particularly important during the staffing shortages during the COVID-19 pandemic. The process is now an embedded practice in all WellSpan acute care hospitals.

The innovation team believes that the remote nature of the CAT is a key factor to the success of the system. By routing alerts to remote nurses, the clinical team is less susceptible to alert fatigue, and remote clinicians can perform clinical observations and monitoring with fewer distractions and competing priorities. Also important is the adjustable alert algorithm. By using data and feedback, informatics staff can collaborate with clinical teams to adjust the algorithm and alerts, which prevents unnecessary disruptions and allows for greater sensitivity and specificity to signs of sepsis.

The innovation focused on reducing mortality by improving response to and management of sepsis.

Important components of the innovation include the following:

• Multidisciplinary teams stationed at each hospital location to oversee implementation
• Standardized EHR alert technology across all locations
• Established, evidenced-based, clinical criteria to inform local protocols on response to sepsis
• Information technology experts to customize and set up the alerts system
• Key performance indicators and timely transparent reporting of unit, team, and individual performance
• Adoption by staff at all levels
• Specialty-trained, experienced remote alerts team
• Communication channels for clinician-remote team collaboration
• Role-based training on the new system for all staff
• Opportunities for cross-functional representatives to build trust, share ideas, and seek help

The team at WellSpan has received inquiries from approximately 30 organizations seeking information on the innovation.