In 2019, the hospital sought opportunities to improve early identification of deterioration.  This nominee was promoted from an ICU Clinical Lead to a Program Manager to initiate the Patient Response Program (PRP) to address this opportunity.  Building the program from the ground up, he partnered with other clinical experts, leaders, and interdisciplinary team members to establish a programmatic approach to rapid response and early identification of clinical deterioration.  Prior to this, one of the adult ICUs managed rapid response events and no proactive approach was used to identify or prevent deterioration.

This nominee, who previously worked as a Rapid Response Team (RRT) nurse, brought forward several evidence-based strategies to implement proactive care.  He identified three main roles that the Patient Response Team (PRT) should have:  1) enhanced/proactive rounding; 2) response to RRT events; and 3) bedside education for frontline intermediate/stepdown team members.  In addition to this work, the PRT was tasked to operationalize SepsisWatch, a predictive model to identify patients suffering from Sepsis.

He is a Principle Investigator (PI) for quality improvement and research projects.  Currently, he is leading a study titled, Evaluation of a Patient Response Program on Patient Outcomes and Staff Satisfaction (IRB Pro00109251).  This nominee partners with a nurse scientist and nurse leader to evaluate the effect of a proactive PRP using evidence-based interventions, including proactive bedside rounding and education on patient outcomes and staff satisfaction.  The primary aim of the project is to decrease the number of unanticipated transfers to the intensive care unit at Duke University Hospital, and the secondary aim is to improve the support of intermediate/stepdown nursing teams in identifying patient decompensation and escalating concerns related to patient condition.  This nominee is leading the intervention by initiating the PRT and the work that drives this model of proactive care.  He is dedicated to disseminating knowledge to address current and future needs.  His innovative thought process, relationship-building skills, and commitment to improving patient care are qualities that lead him to success in creating and embracing discovery.

This nominee strives to improve care delivery and patient outcomes through a data-driven approach.  He led efforts to implement strategies that facilitate early identification of patient deterioration in the intermediate/stepdown setting.  He leveraged innovative technology and created consistent workflows to guide proactive rounding.  His work also enhances the team’s ability to respond to emergencies, including Rapid Response, Code Blue, and Stroke Codes.  Before this team, our Rapid Response Team was underutilized and lacked any proactive approach for identifying patients who were deteriorating.

The key indicators of this work defined by the nominee and colleagues include rapid response volume, unanticipated transfers to the ICU, and staff satisfaction.  Between fiscal years 2020 and 2021, our hospital had a 20.7% increase in rapid response events, with an average of 175 events per month in 2021.  Next, implementation of the PRT and the proactive identification of deterioration led to a 29.3% decrease in unanticipated ICU transfers between March 2020 and March 2021.

While this nominee uses technology and data to make decisions, he holds a strong ability to build relationships and influence people.  He is conscious of leading people and modeling the American Organization of Nursing Leadership’s Nurse Manager Competencies, which reflect on the importance of “fostering a culture where interdisciplinary team members are able to contribute to optimal patient outcomes and grow professionally.”

The structure of the PRP provided this nominee the opportunity to initiate a Behavioral Emergency Response Team (BERT) under a similar structure to the PRT, fulfilling a hospital need.  Because the model used for PRT is flexible, the nominee partnered with clinical experts across the health system, including Clinical Education and Professional Development, psychiatric health providers, Nursing, Chaplains, Security, Performance Services, and many others, to create the new BERT.

The Chaplain Services Team collaborated with the Code Blue Oversight Committee, which the nominee is an active member of, to establish a process for Family Presence During Resuscitation (FPDR).  Historically, families would not be present during resuscitation of their loved one, which contradicts our Professional Practice Model.  Swanson’s Theory of Caring guides us toward “avoiding assumptions, centering on the one cared-for, assessing thoroughly, seeking cues, and engaging the self of both.”  The FPDR process provides a safe, consistent way for loved ones to witness the resuscitation efforts.  This work exemplifies Swanson’s Theory of Caring, specifically through the Caring Behavior of Knowing, which is defined by “striving to understand an event as it has meaning in the life of the other.”  Research has shown that for families who wish to observe resuscitation efforts, there were many benefits.  This nominee was a champion for this work and led the collaboration between the Code Blue Oversight Committee, Chaplain Services, PRT and local nursing teams.  He helped draft the wording for an update to the Code Blue Policy and led the integration with the local teams through nursing education.

This nominee uses advanced leadership skills to transform our hospital’s clinical emergency response processes, and leads efforts to improve patient outcomes, reduce burden and stress on the frontline staff, and enhance available resources.