A recent study published in Critical Care Nurse highlights a remarkable achievement at a Texas cardiovascular specialty hospital, where a dedicated shock team has successfully reduced the time it takes to diagnose patients with cardiogenic shock by more than 50%.
Baylor Scott & White The Heart Hospital—Plano, a 105-bed facility in North Texas, implemented a multidisciplinary approach to address the urgent needs of patients facing cardiogenic shock. This serious condition often arises from ischemic heart disease, with over 80% of cases occurring following an acute myocardial infarction. The purpose of the shock team is to enhance the timely identification of symptoms and streamline care among specialized healthcare providers, including physicians and nurses.
A retrospective analysis of internal data indicated that the shock team’s initial implementation had not yet resulted in noticeable improvements in patient outcomes. Furthermore, this review uncovered inconsistencies that could hinder the prompt recognition of cardiogenic shock in patients.
“Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation
” details how a quality improvement initiative led by hospital nursing staff made significant strides in reducing the time from the first signs of distress to diagnosis for admitted patients and the duration from the initial transfer request to acceptance for patients coming from referring hospitals.
Co-author Suzanne Krais, DNP, RN, NEA-BC, CCRN, who serves as the hospital’s chief nursing officer and vice president of patient services, shared insights into the initiative.
“Rapid response teams have been crucial for patients with rapidly declining conditions or sudden changes in status, but many patients with cardiogenic shock have gradual physical changes over several hours or even days,” she explained. “Nurses play a pivotal role in activating shock teams by providing initial assessments and recognizing trends in patients with complex medical conditions. Through this initiative, we developed specific tools to help nurses and other clinicians know when to escalate a patient’s treatment to the shock pathway.”
A key component of this initiative involved educating the nursing team. The hospital’s shock consortium devised an algorithm to aid in assessing and treating cardiogenic shock patients, utilizing the acronym SALUDE to guide nurses and clinicians through identifying symptoms and the steps necessary to activate the shock team.
Educational sessions were designed to be concise, lasting between 15 to 30 minutes, and included in-service training, new hire orientation, daily huddles, and monthly unit meetings. Each member of the shock team received individualized education to clarify their specific roles and responsibilities.
The initiative also introduced a dedicated emergency alert system for the shock team, utilizing the Everbridge communication platform. This system sends HIPAA-compliant alerts via email and text messages and retains valuable data on alerts for future review. The collected information has been instrumental in creating a database for metric evaluation, process enhancements, and benchmarking.
For this study, the researchers analyzed pre-intervention data from 25 patients admitted between April and May 2021 and compared it with post-intervention data from 45 patients admitted during the same months in 2022. The findings revealed a significant decrease in the mean time to diagnosis, plummeting from nearly 18 hours to 8.15 hours. Additionally, for patients with cardiogenic shock transferring from referring hospitals, the median time to acceptance dropped dramatically from 1.55 hours to just 0.35 hours.
The analysis indicated no significant differences in mortality rates, usage of mechanical circulatory support, length of hospital stay, or duration of mechanical circulatory support between the two patient groups, likely due to the study’s small sample size and short time frame.
As a result of this initiative, the hospital now participates in the national cardiogenic shock registry established by the American Heart Association. The registry aims to standardize care, enhance collaboration, and establish benchmarks.
To access the article abstract and full-text PDF, visit the CCN website here.
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