Recognize and Rescue initiative optimizes patient outcomes

Collaborative Approach Shares Best Practices For Quality And Safety

Clinical leaders across Ascension are redoubling efforts to improve clinical quality and patient outcomes.

“Healthcare as a whole was disrupted by the COVID-19 pandemic,” said Mohamad Fakih, MD, MPH, Chief Quality Officer, Ascension. “Across the nation, hospitals experienced many challenges with a high proportion of patients presenting with respiratory compromise. We witnessed patients decompensating and requiring intensive care, a rise in healthcare-associated infections and increased hospital mortality. To help enhance our outcomes, we formed an Ascension comprehensive initiative called Recognize and Rescue.”

Recognize And Rescue

The goal of Recognize and Rescue is to optimize quality and safety across acute care sites through the prevention of negative events and the delivery of prompt support for decompensating, or functionally deteriorating, patients. The work underscores multidisciplinary partnership and the adoption of standardized procedures for patient care.

The initiative organizes its work into two components:

• “Recognize”: Recognize high-risk conditions, situations and medications and prevent negative events. Focus areas include: (1) Implementing risk-reduction strategies for healthcare-associated infections. (2) Mitigating medication risks. (3) Improving the management of sepsis. (4)

Optimizing the management of patients with respiratory compromise. (5) Practicing person-centered engagement.

• “Rescue”: Identify early and promptly intervene to support the decompensating patient. Focus areas include: (1) Standardizing rapid response team and code team protocols and processes. (2) Encouraging escalation and use of chain of command for concern resolution. (3) Prioritizing front-line healthcare worker education. (4) Promoting teamwork.

Each market established a team to lead this work with representation from multiple disciplines including physicians, nursing, respiratory therapy, pharmacy, analytics, education, consumer experience, environmental services, risk, and quality and patient safety.

Since its inception, Recognize and Rescue has had a major impact on improving patient outcomes. Its implementation of best practices to reduce healthcare-associated infection events led to lowering central line-associated bloodstream infections by 18%, hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infections by 29%, catheter-associated urinary tract infections by 21% and hospital-onset Clostridioides difficile infections by 14%. In addition, it has helped reduce severe hyperglycemia by 14% and acute kidney failure by 35%.

Compared to the prior year and on a risk-adjusted basis, mortality also improved by 17%.

Best Practices In Action

At Ascension St. Vincent in Indianapolis, the Recognize and Rescue team partnered with its educators to integrate best practices for resuscitation training including planning guides and mock code observations into the hospital’s simulation education program. They developed mock scenarios for a range of disciplines from progressive adult care to pediatrics.

“Simulation education allows teams to practice scenarios such as mock codes so they feel more prepared, comfortable and confident when they do occur,” said Stephanie Tooley, Vice President, Quality and Safety, Ascension St. Vincent. “Through training, our teams can better identify opportunities to improve how they work together and optimize patient outcomes.”

In addition to training and sharing best practices, understanding the important role each member of the care team plays is a key driver of this work.

At Ascension Via Christi in Wichita, Kansas, the Recognize and Rescue team applied the initiative to ensure the ministry was using its rapid response teams to their fullest potential.

Rapid response teams help units across the hospital recognize urgent patient needs and are used to help initiate response for assessment, intervention and patient triage. Examples of when a rapid response team would be called could include a concern about a change in a patient’s status such as heart rate, cardiac rhythm, blood pressure, respiration rate, oxygen saturation, level of consciousness and more.

“Some of our Ministry Markets’ rapid response teams may be solely nurse led while others may include physicians or advanced practice clinicians, emergency department personnel, respiratory therapists, chaplains and more,” said Missi King, MBA, BSN, RN, Director, Cardiovascular Service Line, Ascension Via Christi. “Our goal with Recognize and Rescue is to ensure we are practicing with a purpose and sharing the latest best practices so we can draw out the best in each team member.”

REAFFIRMING OUR COMMITMENT TO HIGH-QUALITY CARE

“Recognize and Rescue has set a strong foundation for how we provide care to our patients,” said Richard Fogel, MD, FACC, FHRS, Executive Vice President and Chief Clinical Officer, Ascension. “Through this coordinated approach, we have made tremendous strides in optimizing patient outcomes. From introducing new training to reducing healthcare-associated infections, our cumulative efforts are making a difference and saving lives. This is an incredible testament to our care teams’ resiliency and commitment to deliver high-quality, safe care to the patients we serve.”