Published in the December 2006 issue of Today’s Hospitalist
If you’re a patient at Shadyside Hospital and you need serious care quickly, you can expect to see the rapid response team. But if you or your family has critical needs or urgent questions about your care, the members of another team will likewise rush to your bedside.
That’s because Shadyside, which is part of the University of Pittsburgh Medical Center Health System, has taken the concept of rapid response teams and given it a new twist. Under its “condition H” program “the H stands for help “a team similar in makeup to a rapid response team responds to patients’ and families’ critical concerns.
The condition H program is an alert system that allows patients and family members to call the same in-house phone number used by nurses and residents to connect with an emergency operator.
Once a call is made, the team, which includes a non-teaching house physician, responds within minutes. (Shadyside’s house physicians admit all patients and provide cross-coverage when asked. Unlike traditional hospitalists, however, they do not medically manage admitted patients.)
“Condition H allows a patient to call and say, ‘I’m not comfortable with what’s happening right now and I need help,’ ” says Neena Reddy, MD, a Shadyside house physician. “Patients have either a realistic or a perceived apprehension about their care that needs to be addressed immediately.”
The genesis of condition H came from the Institute for Healthcare Improvement, which urges hospitals to give patients opportunities to signal emergent situations or ask urgent questions about their care.
That message caught the attention of Shadyside executives who decided to give the concept a try. In early 2005, Dr. Reddy and another Shadyside house physician attended the meeting where implementing the project was first discussed.
“We were a little hesitant,” she says. “The idea of patients or family members being able to call a condition on themselves at any time was disconcerting because we didn’t know what to expect.”
Their initial fears? That patients would overwhelm the staff with calls to have their bedpans changed or to complain about the food. But since the system went live in July 2005, those fears have proved groundless. In the project’s first 15 months, condition H has logged only 41 calls.
Several calls have focused on pain management. Other callers have questions about medical management, psychosocial concerns such as a lack of support at home, and discharge planning, as well as diet and dietary concerns, says Beth Kuzminsky, RN, a project manager with the health system’s center for quality improvement and innovation.
“Usually, the problems “even those that aren’t health care-related issues “are linked to some type of breakdown in communication,” Ms. Kuzminsky says.
Refining the process
When condition H was first rolled out, the five- to six-member response team included the house physician, a nursing supervisor, a patient representative and floor staff.
But the team soon hit what Dr. Reddy called “some rough spots” that pointed to the need to refine the concept. To help the program evolve, the team ended up reviewing each condition H event to decide what to keep, what to change and what to streamline.
For one, the team realized that when patients were admitted, they needed more information about the system and what would happen if they called the emergency number.
They needed to know, for instance, that condition H should be reserved for only critical or emergent questions “and that when they call, they “activate an entire team, including a physician,” says Dr. Reddy. To get the word out, the hospital designed new patient brochures that are handed out at admission. They also made sure that admitting personnel discussed how to use the condition H program with patients and family members.
Project leaders also streamlined the questions that emergency operators use to determine if patients are calling with a housekeeping issue or a true health-related problem.
Finally, team members changed their own responsibilities and mode of response. For one, the entire team initially responded when calls would come in. “It was a little chaotic,” says Dr. Reddy.
And originally, the house physician acted as the team coordinator. But that became an issue when patients called with non-medical issues, such as questions about discharge. Instead, the hospital’s patient relations staffer and nursing supervisor now act as team coordinators and are the first team members paged. Part of their immediate assessment is deciding whether or not to call the physician.
“You don’t want physicians responding to every question, especially those that aren’t medically related,” says Dr. Reddy. “This is a much better allocation of resources.”
Still, Dr. Reddy points out, the time and expense it takes to institute a condition H team have been minimal. “We spend more time talking about the cases than responding to them,” she says. “For all our concerns about how calls would drain resources, that just hasn’t happened.”
To find out how well condition H is working, the patient relations staff surveys patients within 24 hours of their making a condition H call. According to Ms. Kuzminsky, 86 percent of patients say their needs were met by responding physicians, 100 percent say their needs were met by responding nurses and 90 percent say they would call the condition H number if the situation warranted it.
In addition, personnel from the health system’s risk management department and center for quality and innovation have reviewed condition H calls and found that team actions averted potentially harmful events in 69 percent of the calls placed. Averted events include respiratory compromise, medication errors, skin breakdown and potential falls.
The results have been so impressive that another hospital in the University of Pittsburgh health system “Children’s Hospital of Pittsburgh “has implemented its own condition H program.
And starting last month, quality improvement personnel began meeting monthly with Shadyside’s condition H team members to find ways to spread lessons learned from condition H calls system-wide.
Most important, says Dr. Reddy, condition H promotes better communication among patients and providers, as well as better continuity of care. She’s responded to several calls from patients who have come into the hospital with four or five different consults and have heard something different about their condition from each physician.
That leaves patients confused about their prognosis and treatment plan. “Often, I come in and find out that they don’t understand what is happening,” says Dr. Reddy. “That’s led to their distress and their phone call.”
Condition H has also revealed the need for more comprehensive pain management, a common focus of many of the calls. When she responds to those calls, says Dr. Reddy, she may get in touch with patients’ physicians to let them know to give patients more information about their pain management plan.
Other times, she’ll go ahead and increase patients’ pain medications. But even in situations where she doesn’t adjust their drugs, patients appreciate the few minutes she is able to spend.
“If you just go to sit and talk to patients,” she says, “often they’re happy just to know that somebody took the time to come and see them.”
Janice Simmons is a freelance health care writer based in Alexandria, Va.