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A Canadian Hospital Leverages IT to Optimize the Prevention of “Code Blues”

March 17, 2017
by Mark Hagland
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Leaders at Hamilton Health Sciences in Ontario optimize clinical processes to avert patient emergencies

IT and clinician leaders are breaking important ground at Hamilton Health Sciences, the six-facility health system in Hamilton, Ontario, Canada, an academic research teaching facility affiliated with McMaster University that serves a 2.5-million population in Ontario, and that encompasses a children’s hospital, labor and delivery, and a cancer center, with 12,000 staff.

At Hamilton Health Sciences, vice president of health information technology services and CIO Mark Farrow, who leads a team of about 140 IT professionals, has been co-leading an important initiative around the alerting of clinicians to the rapid deterioration of patient conditions, along with Alison Fox-Robichaud, M.D., a physician in the Department of Critical Care. Farrow brought together a project team of five clinical informaticists, with five clinicians led by Dr. Robichaud.

Essentially, what Farrow, Fox-Robichaud, and their colleagues have done, is this: they’ve built an automated alerting system, leveraging Android smartphones, that involves the alerting of a rapid response team to patient condition results that show the deterioration of patients who are on the regular medical/surgical floors of the inpatient hospital. The Hamilton Health Services leaders have partnered with the Toronto-based ThoughtWire and with the Armonk, N.Y.-based IBM Corporation, to develop the fully automated solution. The results have been strong, including the virtual elimination of code-blue alerts in the inpatient hospital, and a drastic reduction in ICU admissions from the med/surg floors.

For their innovative work in this area, the Hamilton Health Services leaders in January received two awards from the Intelligent Health Association, an association of information technology vendors. It received both the IHA’s 2017 Award for Improving Patient Care and Health Delivery, and its 2017 Intelligent Health Grand Award.

As ThoughtWire noted in a press release issued on Jan. 23, “Through the use of an innovative early warning score (EWS), HHS is improving hospital safety by eradicating in-hospital cardiac and respiratory arrests.  With the EWS, clinicians are apt to respond to abnormal vital signs before patients progress to experience in-hospital arrests. “We believe that most cardiac arrests in an acute care setting should be considered a failure to rescue,” said Alison Fox-Robichaud, M.D., the clinical leader behind the Early Warning Score (EWS) project.  Dr. Fox-Robichaud’s clinical team was complimented by members of the Health Information Technology Services group led by Mark Farrow, vice president and chief information officer at Hamilton Health Sciences. 

To enhance this initiative and move toward achieving even better care outcomes, HHHS collaborated with ThoughtWire and IBM Canada to find an innovative way to address the key factors that were inhibiting the initial EWS results.  Leveraging ThoughtWire’s Ambiant Health Platform, the team created a Mobile Early Warning Score Application that works in real time with Meditech. Today, nurses capture vitals at the bedside on their mobile devices. The data is then integrated into the Meditech electronic medical record system, which computes the EWS.  Based on HHS research, each score prompts the Ambiant Platform to drive a standard set of notifications and responses to the appropriate members of the care team, while machine intelligence ensures that standardized best practices are consistently executed. 

The early results have been powerful: HHS has seen a 17-percent decrease in the number of Critical Care Response Team consults requiring ICU admission and a 6-percent reduction in cardiopulmonary resuscitation (CPR) requiring Code Blue calls.  “Before rapid response teams were in place, you would hear code blue calls on average once or twice a day in the hospital’s wards,” Dr. Fox-Robichaud, said. “Fast forward to 2016 and I can now go an entire week without hearing a code blue on the wards. While they have not been eliminated, we hear far fewer – and that means that patients are staying safe.”    

Farrow spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this initiative. Below are excerpts from that interview.

Tell me about the origins of this initiative?

The Hamilton Early Warning Score (HEWS) started as a research project, and it was one of our residents’ research projects on a couple of units. We very quickly saw the merits of it and looked to see what we could do to move it forward very quickly. And one of the challenges is always, when you find evidence, how do you move it to the bedside? So, we first created it on paper to build it out, and quickly built it into the Meditech system. There wasn’t a lot of process, but it allowed us to process it and have the scores calculated automatically, and it would populate an action plan based on a score. We needed to reduce a lot of lag time. While people were documenting in Meditech, they weren’t necessarily documenting in real time. And it’s not helpful to document at the end of the shift, and have the system say, oh by the way, your patient was going to have a heart attack three hours ago, when they already did. So, it needs to be done in real time. You need to be able to create it as part of the culture of the unit. And the way to do that is to not only show that there’s benefit to this, and in a way, that doesn’t impede their workflow.


Mark Farrow

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