Humber River Health’s Command Centre Generation 2

By Humber River Health

Generation 2 of Humber River Health’s Command Centre focuses on early detection and prevention of harm for patients at risk of clinical deterioration and sepsis

Humber River Health is on a mission: to detect the risk of deterioration and sepsis earlier so that healthcare staff can intervene sooner to prevent patient harm and save lives.

Imagine walking into a hospital with a urinary tract infection, or pneumonia, or a surgical site that gets infected — and within hours developing a high fever, having difficulty breathing, and feeling confused.  These are just some of the early warning signs of clinical deterioration that can lead to sepsis — an overwhelming immune system response to an infection – which can lead to death.  Data from the Canadian Patient Safety Institute and Canadian Institute for Health Information shows that 1 in 18 hospital stays in Canada involved at least 1 harmful event, in 2014-2015. 37% of those events were related to infections.

This week, Humber River Health implemented an innovative solution to address the risks associated with clinical deterioration and sepsis, with the aim of reducing incidents of patient harm to zero.

The first phase of the Hospital’s Command Centre included a Wall of Analytics™ that provides advanced real-time and predictive insight, which triggers cross-functional staff co-located in the Command Centre to take action.  This team works together to synchronize care delivery activities (e.g. patient discharge), eliminate delays in care and resolve patient flow bottlenecks (e.g. transferring patients from emergency to an inpatient bed) as soon as they are detected in the Command Centre.

With the launch of Generation 2 of our Command Centre underway, we have introduced an evidence-based practice for tracking a patient’s early warning score called the National Early Warning Score (NEWS) 2.  The NEWS 2 algorithm from the Royal College of Physicians, UK (2017)1, has been built directly into the vital sign monitors that a frontline nurse or care provider uses when monitoring the blood pressure, temperature, oxygen level and other vital signs of each patient.

“Humber River Health is focused on high-reliability health care.  We are implementing cutting-edge solutions through Generation 2 of our Command Centre to ensure that patients receive the highest quality of care in alignment with our values of Compassion, Professionalism and Respect,” says Barbara Collins, President and CEO, Humber River Health. “It’s the type of care each of us would want for ourselves and our family members.”

As vitals are uploaded into the monitor, a NEWS 2 score is displayed as well as recommendations for an actionable clinical response.  It alerts nurses on the frontline to the frequency a patient’s vital signs should be monitored based on the score and provides indications for escalation of care.

“Currently, we are the only hospital in Canada implementing this process with the Command Centre, which provides an additional level of vigilance for patients,” says Jane Casey, Program Director, Emergency Services and Command Centre.

Once a nurse completes taking a patient’s vital signs, they are able to seamlessly ‘save’ the vital sign information and ‘send’ to a patient’s electronic medical record for documentation.  This feature allows NEWS 2 scores and clinical action to be incorporated across our electronic system platforms, to alert physicians and nurses about the patient’s overall physiological status and risk – and used during shift handoff report to ensure continuity of care.  A high NEWS 2 score has been shown to be indicative of detecting patients with sepsis, or those at risk of clinical deterioration.

“Early detection and clinical action saves lives – knowing the patient’s condition, and intervening appropriately to prevent deterioration and sepsis is critical,” says Christina Moldovan, RN and Clinical Practice Leader, Inpatient Surgery.

“We’re ensuring a plan is in place to take action faster,” adds Paul Pangilinan, a nurse and champion of the NEWS 2 implementation team.

NEWS 2 has recently been implemented at Humber River Health, as a Pilot on two inpatient units. Over the coming months, it will be put into operation hospital-wide on all inpatient units, and the Emergency Department.

“We are a hospital that focuses on high-reliability care – patient safety and patient outcomes are at the heart of everything we do,” added Jhanvi Solanki, Program Director, Surgical Services and Maternal-Child Programs, and Co-Chair for Generation 2.

[1] Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017.