Reducing Patient Harm and Improving Outcomes Using Technology
Robbie Freeman, MSN, RN, NE-BC; Herb Perry, BNS, RN; Colleen Fischer, MSN, RN, NE-BC; Eric Grant, RN; Sophia Sharpe,
RN; Loida Gaurano, RN; Esther Jean-Gilles, RN; Andrea Kelly, RN; Edith Rodriguez BSN, RN; Basya Bloch BSN, RN; Adele
Marquez BSN, RN; Hopal McDonald BSN, RN; Amina Mezzoud BSN, RN; Patricia Diaz BSN, RN
Visibility + Transparency + Incentive + Competition = Positive Outcome
Background
The Mount Sinai Health System sets
aggressive goals on the improvement
of patient safety. Many of these goals
are realized by hardwiring safety
mechanisms and process recognition
into nursing workflows.
To drive progress in quality and patient
outcomes, the site-specific solution at
Mount Sinai Beth Israel incorporated a
systematic initiative to highlight
clinical issues in real time.
Project Aim
The development of a mobile-based
facility- and unit-view of the patient
population, with key clinical and process
information for Mount Sinai Beth Israel.
The project set three design goals:
Goal 1:
EARLY RECOGNITION
Use of a real-time view maximized impact
by driving early recognition in the following
crucial areas:
• Early recognition of past-due clinical
process measures at the facility and
unit level
• Early recognition of out-of-compliance
care at the facility and unit level
• Early recognition of patients presenting
with potential sepsis to speed
diagnostic workup
• Early recognition of at risk patients
Goal 3:
ROBUST OUTCOMES METRICS
With a strong starting emphasis on
metrics, baseline data was captured for all
care elements. Identification of a medicalsurgical control unit (unit 1 on chart) and
two medical-surgical pilot units (unit 2 and
unit 3 on chart) provided settings for
rigorous measurement, which took place
for 90 days during each shift. All metrics
were aligned against a preimplementation baseline.
The project set two outcome goals:
Goal 1:
30% REDUCTION IN MISSED CARE
Goal 2:
100% INCREASE IN SEPSIS EARLY
IDENTIFICATION
Project Design/Strategy
An interdisciplinary committee of
executive leadership, including the Mount
Sinai Beth Israel CMO, COO, and
Assistant Director, Nursing Quality
Initiatives, Sepsis Clinical Coordinator,
Nurse Managers, Staff RN’s and resident
physicians was formed. Senior executive
support from the Mount Sinai system
level by the VP Corporate Information
Technology was drawn upon, and the
system’s healthcare informatics, change
management and product development
contracted firm was utilized.
• All goals and measures were
exceeded.
• Outcomes were measured over 90
days to assess whether the process
improvement effort remained in
control.
Interventions
Two units were selected to pilot the use
of a dashboard-driven clinical support
tool, referred to as the risk manager
application. Utilization of the dashboard
was aimed to support nurse managers
and staff nurses in early recognition of
clinical care issues, as well as early
recognition of potential sepsis cases for
evaluation and rapid treatment.
Goal 2:
CLINICAL WORKFLOW INTEGRATION
Existing workflows that leveraged early
recognition were identified and
championed. Where current workflows did
not exist, workflows were created to
leverage early recognition and drive
standardized change in care.
Outcomes
Sepsis clinical coordinators, and rapid
response team members were also
trained and provided access to the tool.
The tool was implemented with specific
focus on supporting the workflows
shown in the following picture. Reports
detailing comprehensive metrics-driven
progress for all units were provided
weekly, both to the executive leadership
team and the involved nurse managers.
Usage reports were also provided to
committee members in an effort to audit
the level of staff engagement and
compliance.
Next Steps
Sustainability is a key goal in the
success of any performance
improvement effort. The Mount Sinai
Beth Israel leadership team
maintained close engagement
throughout the course of the pilot,
and recognized the importance of the
impact of the project, both in
communicative and operational ways.
Plans for hospital- and system-wide
implementation of the application are
in progress. Additional care issues,
workflows, and barriers are under
systematic and metrics-based
considered. Related efforts to
sustain progress towards patient
safety improvement goals includes
additional early recognition alerting
systems, and evidence-based nurse
handoff.