Automated Early Warning Paging System Improving Patient Outcomes at UH Cleveland Medical Center

UH Clinical Update | January 2023

COVID has kept hospitals and their dedicated healthcare workers scrambling for more than three years now. Physicians, nurses, respiratory therapists and others have treated a steady influx of COVID patients, while at the same time going to great lengths to maintain quality care for those patients in the hospital for other reasons. With staffing shortages, this has often been a herculean task.

“We’ve been busy,” says intensivist Rana Hejal, MD, Medical Director of the Medical Intensive Care Unit at UH Cleveland Medical Center.

Rana Hejal,MD

An understatement, to be sure.

However, as the adage goes, necessity is the mother of invention. To meet this generational challenge, Dr. Hejal and her colleagues at UH Cleveland Medical Center have launched a quality improvement initiative that leverages technology to ease caregiver burden and improve patient outcomes. Dubbed RADAR (Real-time Assessment of Data and Risk), it’s a system that generates an early, automated warning to the hospital’s Rapid Response team at the first signs that a patient is deteriorating and requires additional interventions. Automation means beside nurses are freed up to meet other patient care demands.

What Makes Up a RADAR Score?

The parameters for the RADAR auto page are based on the validated parameter criteria for NEWS (National Early Warning Score), which is an early warning score tool utilized in the U.K. They include:

• Respiration rate
• Pulse oxygen
• Room air or oxygen in the hospital room
• Systolic blood pressure
• Pulse
• Temperature

“We were interested in automating a way to tell at the earliest possible moment that the patient is getting sicker in the hospital -- without having to wait for the nurse to go to the bedside to check things out,” Dr. Hejal says.

Parameters under RADAR are assigned number values.

“Every single time a vital sign is reported in the medical record, and based on a certain calculation threshold and score, it issues a kind of red flag,” Dr. Hejal says. “It then notifies the people who can do a rapid response intervention.”

Growing Use

RADAR auto-pages started at UH Cleveland Medical Center in November 2020 with just 15. By December 2021, the number had grown to 284. Dr. Hejal says the tool has helped her and her colleagues intervene more quickly with deteriorating patients, allowing them to stay on the hospital floor for treatment and out of the ICU.

“The role has been not to prevent admissions to the ICU, but to strategically keep the sickest patients in the ICU,” she says. “Patients who we can take care of on the floor, we keep them on the floor, but with immediate attention to their decompensation.”

Because the patients being treated at UH Cleveland Medical Center are quite ill to begin with, Dr. Hejal says, they may generate a high repeated RADAR score – kind of a false alarm. But, she says, that’s an acceptable trade-off for the ability to intervene early when a patient is truly struggling.

“As far as efficiency, the advantage is our ability to take care of anybody in need, so our ability to rescue is very high,” she says. “The second advantage is ability to prevent code blues on the floors. The goal is to have zero code blues on the floor. We have not achieved it yet, but the trend is going down.”

For patients who do end up in the ICU, Dr. Hejal says the RADAR system is also getting them there sooner, when their chances of a good outcome are greater.

Next Steps

Dr. Hejal says she hopes there will come a day when all the data behind the RADAR score doesn’t need to be manually entered. For now, however, she and the team are operating within the existing constraints, while trying to improve the tool. One key priority, she says, is refining the parameters they use to identify sepsis.

“Being able to capture every septic patient in the hospital, and being able to give them antibiotics within the first hour, is our goal,” she says. “Our aim is zero. We do not want to miss a single septic individual, and we do not want to have any patient with sepsis not getting antibiotics in the first hour of care. RADAR can help with that.”