Interventions for Early Status Changes

Purpose: To utilize an early detection procedure for patients who show changes in vital signs or mental status that allows nurses and providers to promptly intervene. This procedure empowers nursing staff to alert providers that they have detected a medical change and necessitates the provider to promptly assess the patient and deliver interventions to prevent further medical decline.

Description: Nurses provide care to patients 24 hours a day, 7 days a week, and often are the individuals to identify that a status change is occurring in a patient. Changes in status include variations in vital signs, mental status, and fluctuations in therapy participation. With the early status change (ESC) procedure, nursing staff can request an evaluation by paging the provider with one of 7 criteria identified. The provider acknowledges receipt of the page with a phone call and agree to evaluate the patient within one hour. Therapy staff and respiratory therapists can also initiate an ESC with a provider but must discuss with the primary nurse. A text page sent to a provider includes the phrase “ESC,” along with the patient’s initials, room number, and applicable criterion. After an assessment from the medical team that confirms the patient’s status change, the provider will then place an ESC order within the medical record. The ESC order that includes vital signs every two hours for the next six hours and a pop-up alert for care providers. In addition, the provider completes an ESC SOAP note in the medical record. Additional testing may be ordered if warranted. The pop-up alert is a banner that populates for 24 hours as a separate window when the patient’s chart is opened, so all disciplines can be aware of the need for enhanced observation. This communication allows all care team members to be informed remotely about the patient’s condition and helps to identify additional changes in the patient’s status. ESC procedures do not replace current immediate response workflows such as ROC stat or code team calls.

Outcomes: Status changes in patients are often detected by nursing staff. Utilizing a procedure to inform providers when specific criteria are met helps to empower nurses to advocate for their patients and recommend an ESC when only slight changes are apparent. Using the ESC notification procedure allows medical and nursing staff to pay closer attention to a patient who may need additional workup to prevent medical decline and transfer to outside facility. By doing so, therapy time and services are optimized within the inpatient rehabilitation setting