Retrospective Study: Unplanned ICU Admission for Trauma Service 2015-2017

Purpose: Unplanned ICU admissions and/or ICU readmissions and adverse events increase patient morbidity and increase the number of days in the hospital. Adverse events in the hospital are also associated with increased patient mortality. National benchmark goals exist for unplanned ICU admissions. Of the total cases accepted to Trauma Quality Improvement Program, unplanned ICU admissions are twice the national benchmark goal. Significant opportunity exists for identifying these cases earlier during their hospital stay, and intervening in a timely manner that may help reduce their need for higher level of care.

Objectives:

1. Identify patient cases that include an unplanned admission (or readmission) to the ICU or who had other unplanned adverse events that led to an ICU admission.
2. Identify causes for unplanned ICU admissions and adverse events
3. Identify potential early nursing interventions and early assessments that may have prevented deterioration in patient status
4. Utilize an early warning tool, DENWIS, to identify patients that could have been prevented from deteriorating

Methods: Relevant patient charts were review by qualified staff over the period of 2015-2017. Each adverse event that resulted in a patient transfer of care to the ICU were examined by the committee. Underlying causes were identified as the reason for transfer to ICU; cases were identified as preventable or unpreventable. Additionally, it was determined if there were early signs/symptoms or potential signs that should have been identified by nursing staff. It was further identified that if early interventions and communication with provider could have prevented sudden deterioration in patient status.

Results: Opportunities existed for improvement in care. More accurate assessments could be performed and documented by nursing staff. Patients’ charts who had adverse events and those who had unplanned transfers to the ICU demonstrated timely communication with providers of subtle deterioration of the patients over time preceding transfer. Additionally, better documentation of communication of clear communication with providers early notification and interventions ordered could be improved. However, using the DENWIS Tool could have identified patients AND facilitated more clear nurse-to-provider concern regarding the potentially deteriorating patient.

Conclusion: DENWIS could be a critical tool for identifying patients at risk for deterioration.

DENWIS - Dutch Early Nurse Worry Indicator Score