SummaryThe University of Pittsburgh Medical Center Shadyside implemented a Condition Help program that patients or their family members/visitors can activate if they believe that the patient’s condition is deteriorating. An easy-to-make phone call immediately brings in a rapid response team to assess and manage the situation and provide treatment as needed. A pilot test suggests that the program has helped avert potential patient incidents, while generating high levels of patient, family, and staff satisfaction.Suggestive: The evidence consists primarily of post-implementation analysis of the nature of the Condition Help calls and patient, family, and staff satisfaction with the program. As the program matures, data will be analyzed to gauge its ability to prevent adverse events and reduce the risk of deterioration.
Developing OrganizationsUniversity of Pittsburgh Medical Center Shadyside
Date First Implemented2005
Problem AddressedThe warning signs of deterioration in a hospitalized patient's condition are often visible but missed by busy providers.
- Visitors may notice signs of patient deterioration: Visiting friends and family members who spend a lot of time focused on the patient's condition are often in a good position to notice these warning signs.
- But they may not know when or how to notify provider: However, visitors but may not know enough to recognize when these warning signs warrant a call for help. Even when they do, family members and visitors often have a hard time getting the attention of busy providers and/or may be reluctant to question their authority or judgment.
Description of the Innovative ActivityThe University of Pittsburgh Medical Center Shadyside implemented a hotline for patients and their family members to activate via a telephone call when there is a noticeable, urgent clinical change in the patient’s condition and the family is unable to locate a staff member for help or if there is an issue with communication breakdown on how care is being given or managed. The call brings in a multidisciplinary response team to assess and manage the situation and provide any needed treatment or intervention to stabilize the patient. Key elements of the program include the following:
- Staff and patient/family education: Hospital leadership provide education about the Condition Help program to hospital staff. The admitting nurse on the patient’s unit provides a trifold program brochure and reviews Condition Help guidelines with the patients and families. A Condition Help video is played on the hospital patient education channel. There are also signs in patients’ rooms outlining the program, stickers on telephones containing the hotline number, and signs in public areas reminding patients and visitors about the program.
- Activation criteria: Patients and family members are instructed to activate a Condition Help if one or more of the following occurs: a noticeable change in the patient’s condition and the health care team is not responsive to either the change itself or to patient and family concerns, a breakdown in how care is being given, or confusion about what needs to be done.
- Activating the multidisciplinary team: The Condition Help team is led by an administrative nursing coordinator; the team includes an internal medicine physician, a patient relations coordinator, and unit nursing staff. Patients, family members, or visitors can activate a Condition Help by calling the emergency phone number from any hospital telephone. The telephone number provides a direct line to trained hospital operators who obtain the patient’s name, caller’s name, location, and nature of the emergency. The hospital operator uses a decision tree to assist in determining whether pager and overhead alerts should be triggered to speed up response time. The response team comes to the patient’s room promptly to assess the situation and administer any treatment or other needed interventions. If necessary, additional clinical support is summoned.
- Followup: Within 24 hours of every Condition Help call, the patient relations coordinator comes to the room to conduct a bedside interview with the patient and/or family members. This feedback helps the hospital learn how to improve the program and better understand patient needs.
- Ongoing training and reinforcement: A DVD that tells the story of Josie King (an 18-month old whose death due to a medical error potentially could have been avoided if a Condition Help program had been in place) is available for viewing by hospital staff and patients/families as a way to focus them on the importance of patient safety in the hospital environment. The DVD is also used as an ongoing training tool to emphasize the importance of communication and teamwork in ensuring patient safety.
References/Related ArticlesUniversity of Pittsburgh Medical Center. Condition H (Help) [Web site]. 2008. Available at: http://www.upmc.com/mediarelations/newsreleases/2006/pages/rapidresponsesystem.aspx.
Greenhouse PK, Kuzminksy B, Martin SC, et al. Calling a condition H(elp). Am J Nurs. 2006 Nov;106(11):63-6. [PubMed]
Information on the Institute for Healthcare Improvement/Robert Wood Johnson Foundation Transforming Care at the Bedside initiative can be found online at: http://www.ihi.org/offerings/Initiatives/PastStrategicInitiatives/TCAB/Pages/default.aspx.
Contact the InnovatorCindy Liberi, BS
Associate to the Chief Quality Officer
University of Pittsburgh Medical Center
Donald D. Wolff, Jr., Center for Quality Improvement and Innovation
Meyran Avenue, Forbes Tower
Pittsburgh, PA 15213
Phone: (412) 864-3884
ResultsA 9-month pilot test in a 24-bed medical cardiology unit found that the Condition Help program helped to stabilize patients who were at risk of a negative incident and generated high levels of patient, family, and staff satisfaction, which led to a hospital-wide rollout of the program.
Suggestive: The evidence consists primarily of post-implementation analysis of the nature of the Condition Help calls and patient, family, and staff satisfaction with the program. As the program matures, data will be analyzed to gauge its ability to prevent adverse events and reduce the risk of deterioration.
- Appropriate calls: Analysis of the 21 Condition Help calls during the pilot suggests that the majority met at least one of the defined criteria for the program. Most calls were related to communication issues between patients and clinicians, including the need for better explanations of, and/or disagreements about, the current treatment and care plan. Nearly one-fourth (5 of 21) of the calls related to a need for more effective pain management.
- Averting potentially negative incidents: Analysis suggests that 69 percent of the calls may have prevented a negative patient incident; for example, one call was made by a patient experiencing chest pain in the emergency department who felt no one was available to respond to him.
- High levels of satisfaction: The vast majority (86 percent) of patients believed their needs were met by the physician who responded to the call, while all patients believed their needs were met by nurses. Favorable initial responses to the pilot program from patients, families, and hospital staff led to its expansion throughout the hospital. The program continues to be used on a regular basis; since the inception of Condition Help through February 2008, there were 116 Condition Help calls at the University of Pittsburgh Medical Center Shadyside.
- System-wide spread: The success of Condition Help at the University of Pittsburgh Medical Center Shadyside has led to the system-wide spread of this initiative. Fourteen hospitals have adopted Condition Help and are currently standardizing Condition Help educational materials and a system data collection tool for measuring Condition Help calls. Using a standardized data collection tool on a rolling 12-month period ending March, 2009, 230 Condition Help calls have been recorded, meeting the needs of the patient and family 88 percent of the time. The top three reasons patients and families have called Condition Help is for pain control/medications, dissatisfaction of staff, and delay in care.
Context of the InnovationThe University of Pittsburgh Medical Center Shadyside is a 486-bed tertiary care hospital. Shadyside has long had a strong commitment to the use of rapid response teams that can be activated by providers who notice deterioration in a patient's condition. The hospital's Vice President of Patient Care Services, at that time Tamra Merryman, heard Sorrell King speak at an Institute of Healthcare Improvement (IHI) national forum in 2004 about the series of hospital errors that led to the death of her 18-month-old daughter, Josie, and the fact that she noticed something was wrong with her daughter but could not get an adequate response from providers. Ms. King promoted the idea of a patient- and family-activated system to call for immediate help when a patient appears to be in trouble. Ms. Merryman took this idea back to senior leaders at Shadyside and got approval for the Condition Help program. The University of Pittsburgh Medical Center was one of three health systems across the country chosen to participate in a pilot program to focus their health care operations on a more patient-focused environment. This program is part of the IHI and the Robert Wood Johnson Foundation's "Transforming Care at the Bedside" initiative; the program was pilot-tested as a way to improve patient care delivery through use of a four-point framework: safe and reliable care, staff vitality and teamwork, patient-centeredness, and value-added processes.
Planning and Development ProcessKey steps in the planning and development process include the following:
- Patient interviews: Interviews were conducted with patients and family members to get a better understanding of their concerns and how best to design the program to meet them.
- Selling the program: The benefits of the program were explained to physicians and hospital staff to win their support, including telling Josie King's story.
- Development of educational materials: Brochures, posters, wall signs, newsletter articles, and other communication pieces were developed to create initial and ongoing awareness of the program.
- Pilot test: A small test of the program was conducted with actual patients on a "Transforming Care at the Bedside" unit and refined as necessary.
Resources Used and Skills Needed
- Personnel: No additional personnel are necessary for the program, which is staffed by existing employees as a part of their regular duties.
- Costs: The program entails minimal costs to develop and operate; the Josie King Story DVD is available through the Josie King Foundation with a suggested donation of $250.
Funding SourcesSorrell King—a major advocate for patient safety since the death of her 18-month-old daughter as a result of medical errors at a respected U.S. hospital—provided funds and assisted in the development of the Condition Help program.
Tools and Other ResourcesMore information on the program and the Josie King Foundation is available at: http://www.josieking.org/page.cfm?pageID=18.
General information on rapid response systems is available at: http://psnet.ahrq.gov/primer.aspx?primerID=4.
Getting Started with This Innovation
- Build rapid response teams first: The Condition Help initiative builds on rapid response teams.
- Do not get bogged down considering hypothetical "what-if" questions: This will stall progress; instead, commit to the notion of pilot testing and learning from actual experience and mistakes.
- Keep data measurements simple: Standardize the process for reporting performance on key metrics.
Sustaining This Innovation
- Evaluation outcomes: Continually evaluate the nature of Condition Help calls and program outcomes to identify areas for improvement.
- Enlist leadership support: Leadership is vital in spreading the program throughout the hospital.
- Use the 8-minute Josie King Story DVD: Use the video on a periodic basis to maintain awareness of the program and its importance in promoting safety; the video sends a powerful, personal message that can have a lasting impact on those who see it.
Use By Other OrganizationsThe University of Pittsburgh Medical Center spread the Condition Help program throughout the entire system at 14 hospital sites. It was implemented by Children’s Hospital of Pittsburgh at University of Pittsburgh Medical Center in September 2005 and then by University of Pittsburgh Medical Center Presbyterian shortly after that. As of February 2008, all University of Pittsburgh Medical Center–affiliated hospitals have incorporated this program. Standardization of education materials and metrics are currently being coordinated.
Information provided in May 2011 indicated that the innovator receives about 25 calls a year on average from hospitals across the country inquiring about the innovation.
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Service Delivery Innovation Profile
Original publication: December 12, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: July 11, 2012.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: May 03, 2011.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.