In our five-hospital system, the swarming process published in literature was adapted to address resuscitation events outside the Intensive Care Units or Emergency Departments. The swarming process includes an interdisciplinary review that starts with the patient condition 24 hours prior to the event along with patient specific trends, communications and actions. The detailed reviews should occur within one week of the event. Standardized data is abstracted from each case following interdisciplinary discussion. Aggregated data is shared with system-wide team. Over past year, a 60 -70% reduction in resuscitative events outside critical care at our two largest hospitals has occurred.
Tool: Swarming
Problem: Resuscitation events outside of the critical care setting can have more adverse effects than if they occurred within. In aligning with the organizational-wide goal of reducing mortalities, a process for swarming of resuscitation events was implemented, co-led by our clinical nurse specialist and an intensivist.
Tool Selection: Several years ago, there was an article published in the NAHQ Journal where swarming was used to reduce patient falls. We adapted their methodology to address the topic of resuscitation outside critical care. An emphasis on early recognition was made and the tool has been modified over the years.
Usage: We now have a standardized review tool that all departments use after a resuscitation event. The unit where the event occurred initiates the review, including input from other disciplines. This is presented to the interdisciplinary review team within a week of the event. Consensus is achieved on the next steps.
Results: We have since built a database to track all of the assessments and outcomes from the interdisciplinary review. Analysis of the data allows us to identify priorities for education and process change. Time is the biggest barrier as the reviews must occur timely to ensure accurate feedback and understanding.
