New communication bundle reduces unplanned ICU admissions

Editor's Note

Unplanned admissions of medical-surgical patients to intensive care units (ICUs) dropped after a New Hampshire Medical Center implemented a new early warning score communication bundle, this study finds.

The hospital embedded a seven-item modified early-warning score system into the electronic medical record (EMR) for patients in its four medical-surgical units and ICU.

Scores higher than 4 (scale 0-21) automatically activates a red exclamation point next to the patient’s name, which is visible to the nurse and unit secretary. The early-warning score also triggers an electronic page to an ICU nurse preassigned to respond to rapid response team (RRT) calls. The ICU nurse then reviews the patient’s EMR and consults with the patient’s nurse by telephone. In addition, the score prompts a reassessment of at least one item on the early-warning scale by the patient’s nurse.

After implementation, ICU admissions of patients after RRT calls declined significantly, as did ICU admissions of patients with early-warning scores greater than 4, suggesting that patients with deteriorating conditions were identified early.