Cardiac arrests occur in over 290,000 adult inpatients each year in the U.S. Eighty percent of in-hospital cardiac arrests (IHCA) are associated with signs of clinical deterioration anywhere from eight to 24 hours before the IHCA. Escalation protocols guiding nurses to respond to assessments based on early warning scores have decreased cardiac arrests, especially outside critical care units.
The Emergency Resuscitation Committee includes Critical Care Outreach Team (CCOT) members, nurses, physicians (emergency and intensivists), nurse leaders, emergency medical services liaisons and pharmacists, among others. Rush University Medical Center’s IHCA data is reviewed monthly. At the December 2023 review meeting, the committee identified an opportunity to pilot the National Early Warning Sign (NEWS) on select medicine units due to the effectiveness documented in the literature. The identified units included 9 Kellogg (9K), 9 North Atrium (9NA) and 9 South Atrium (9SA). This project aimed to decrease the sentinel or unexpected events related to IHCAs within these acute care medicine units.
NEWS project leads included Heather Cook, MSN, RN, CCRN, NE-BC, CPPS, CNL (CCOT team lead), and Katie Lee Heidt, BSN, RN, CCRN, CCOT, a clinical nurse, and Rush University doctoral nursing student. The project leads partnered with the pilot unit directors (UDs) Jill Ehrenreich, MSN, RN, CMSRN (9K); Carline Guerrier, MSN, APRN, AGPCNP-BC (9NA) and Judy Sy Alido, MSN, RN, CMSRN (9SA). Additionally, the team included residents, hospitalists and an information technologist, adding the new scoring tool to the electronic medical record.
The clinical benefit of the NEWS score is that it automatically calculates when the clinical nurse enters the vital signs and clinical assessments into the medical record. This systematic approach removes clinician practice variation. When the NEWS score equals or exceeds seven, communication between the clinical RN and the provider triggers a conversation and often leads to upgraded monitoring.
Cook and Heidt provided education for the clinician on the pilot units through 15-minute shift change huddles, emails and readily available educational information sheets. The education focused on the importance of NEWS, the location and functionality of the electronic record, how to utilize the escalation protocol and clarified clinician roles. NEWS scoring and the track-and-trigger process went live at the end of January 2024.
The data from the three-month pilot showed a reduction in IHCAs in these acute care units. The results were presented to the organizational-level Emergency Resuscitation Committee and patient safety recommended a full rollout of the NEWS tool to acute care units.