Automate Vital Sign Collection to Improve Outcomes and Combat Burnout

Through automation, Ardent Health has increased inpatient vital sign collection from four times per day to 1,440 times per day.

Automating the collection of inpatient vital signs has improved the ability to identify patients who are deteriorating at Ardent Health.

Vital signs are critical indicators of a patient's condition in the inpatient setting. Manual collection of vital signs is conducted about four times per day, which is often insufficient to determine whether a patient is decompensating, says F.J. Campbell, MD, chief medical officer of Ardent Health.

The health system has adopted HealthCast, a technological solution that has increased the collection of vital signs to 1,440 times per day, Campbell says.

"We looked for technology that could automate the collection of vital signs. We felt that if we could improve the collection of vital signs, we would be in a better position to identify patients who were deteriorating," he says. "We were looking to improve workflow, take away workflow from the staff who were already overburdened with tasks, and identify the deteriorating patients better."

The data collected by HealthCast has been incorporated into the health system's deterioration index software, which has revolutionized the accuracy and efficacy of Ardent's deterioration index tools, Campbell says.

"We have deterioration index algorithms that look for rapid changes in vital signs, either up or down," he says. "These changes in vital signs can indicate whether a patient is going into respiratory failure, cardiac arrest, hypotension, or some other life-threatening condition."

Prior to adopting HealthCast, Ardent was using the deterioration index in the health system's electronic health record, Epic, to help identify patients who were deteriorating, Campbell says.

"We leaned in on the deterioration indexes that we had in Epic, which helped. But what we were not appreciative of was how limited that system could be without significantly increasing the amount of vital signs that we were collecting," he says. "The deterioration indexes in Epic helped, but there was not enough specificity. The sensitivity and specificity for all of our deterioration indexes went up with more vital signs coming in."

With essentially continuous collection of vital signs at inpatient units, Ardent has improved three key outcomes, Campbell says. The health system has reduced mortality, decreased length of stay, and increased transfers of patients to ICUs. The increase in patient transfers to ICUs shows that the health system is catching deteriorating patients before it is too late to provide them with critical care.

"It is a far better thing to capture someone who needs to go to the ICU than to not capture them in time," he says. "Patient satisfaction has increased because patients feel safer."

Reducing burnout

Automating the collection of vital signs and improving identification of deteriorating patients has reduced burnout among physicians, nurses, and technicians, Campbell says.

"We became aware of the untenable amount of work that we were asking bedside nurses and technicians to do," he says. "Their ability to identify deteriorating patients was their No. 1 source of stress. By extension, if nurses were not in a position to identify patients who could be deteriorating, that made the hospitalists and specialists working in the hospital uncomfortable."

A major source of burnout for anyone in the hospital working at the bedside is fear, Campbell says. "There is the fear that there could be a patient who is deteriorating that we can't identify. So, we tried to figure out what we could do tangibly to reduce this fear."

The emotional burden on clinicians seeing patients deteriorate that they were not expecting to deteriorate usually involves clinicians feeling that they made a mistake, he says. "The absence of identifying the patient who is deteriorating creates a situation that we call the second victim, which is specifically the clinicians. If a patient deteriorates on a clinician's watch, it has a tremendous impact on them. It is a catalyst for clinicians to leave the industry."

Advice for other health systems

Health systems and hospitals should not accept burnout as an inevitable consequence of the work that they perform, Campbell says.

"You do not want burnout to become a form of capitulation," he says. "We need to identify the elements that drive burnout. One example is patients declining on a clinician's watch, which makes the clinician feel they have failed the patient and they have failed themselves in their ability to execute care safely. Deterioration of patients cannot be viewed as, 'That's just the way it is.'"

Another example of a driver of burnout is the sheer number of tasks and burdensome workflows such as vital sign collection and interpretation that clinicians and nurses face, Campbell says.

"The best way to improve workflows is to take them away through automation," he says. "At Ardent, we are militant about workflow, which has gained the appreciation of our staff. Improving our workflows has an impact on our turnover and our recruitment, particularly for nurses and clinicians."