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Effect of a Real-Time Electronic Dashboard on a Rapid Response System

  • Systems-Level Quality Improvement
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Abstract

A rapid response system (RRS) may have limited effectiveness when inpatient providers fail to recognize signs of early patient decompensation. We evaluated the impact of an electronic medical record (EMR)-based alerting dashboard on outcomes associated with RRS activation. We used a repeated treatment study in which the dashboard display was successively turned on and off each week for ten 2-week cycles over a 20-week period on the inpatient acute care wards of an academic medical center. The Rapid Response Team (RRT) dashboard displayed all hospital patients in a single view ranked by severity score, updated in real time. The dashboard could be seen within the EMR by any provider, including RRT members. The primary outcomes were the incidence rate ratio (IRR) of all RRT activations, unexpected ICU transfers, cardiopulmonary arrests and deaths on general medical-surgical wards (wards). We conducted an exploratory analysis of first RRT activations. There were 6736 eligible admissions during the 20-week study period. There was no change in overall RRT activations (IRR = 1.14, p = 0.07), but a significant increase in first RRT activations (IRR = 1.20, p = 0.04). There were no significant differences in unexpected ICU transfers (IRR = 1.15, p = 0.25), cardiopulmonary arrests on general wards (IRR = 1.46, p = 0.43), or deaths on general wards (IRR = 0.96, p = 0.89). The introduction of the RRT dashboard was associated with increased initial RRT activations but not overall activations, unexpected ICU transfers, cardiopulmonary arrests, or death. The RRT dashboard is a novel tool to help providers recognize patient decompensation and may improve initial RRT notification.

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Acknowledgements

The authors wish to thank Abdelhak Abdou, Tom Payne, Christy McKinney, and Peter Tarczy-Hornoch, for invaluable contributions to the study.

Funding sources

The investigation was supported by National Library of Medicine Sponsored Medical Informatics Fellowship LM007442–07.

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Authors and Affiliations

  1. Department of Medicine, Hospital Medicine Program, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359780, Seattle, WA, 98104, USA

    Grant S. Fletcher

  2. Department of Hospital Medicine, Virginia Mason Medical Center, 925 Seneca St, Seattle, WA, 98101, USA

    Barry A. Aaronson

  3. Department of Medicine and the Center for Scholarship in Patient Care Quality and Safety, University of Washington, 1959 NE Pacific, Box 356429, Seattle, WA, 98195, USA

    Andrew A. White

  4. Dupage Medical Group, 25 N Winfield St, Winfield, IL, 60190, USA

    Reena Julka

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Contributions

GF participated in the study design, data acquisition, analysis and interpretation of results, and drafting of the manuscript. BA conceived of the study and designed the intervention. BA also participated in the data acquisition, data interpretation, and revisions of the manuscript. AW participated in the study design, data acquisition, data interpretation, and manuscript revisions. RJ participated in the data acquisition, data interpretation, and manuscript revisions. All authors read and approved the final manuscript.

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Correspondence to Andrew A. White.

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The authors whose names are listed above certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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This article is part of the Topical Collection on Systems-Level Quality Improvement

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Fletcher, G.S., Aaronson, B.A., White, A.A. et al. Effect of a Real-Time Electronic Dashboard on a Rapid Response System. J Med Syst 42, 5 (2018). https://doi.org/10.1007/s10916-017-0858-5

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