Condition H (Help)
A rapid response team that can be called by
hospital patients and their visitors.
At a large east coast hospital, Mrs. Sorrel King lost her 18-month-old daughter, Josie, to narcotic misuse, severe dehydration, and multiple breakdowns in communication. Ms. King believes that if the hospital had had a patient/family-initiated rapid response team, she would still have Josie today. When Tami Merryman, vice president of the UPMC Center for Quality Improvement and Innovation, heard about Ms. King’s experience, she knew that empowering patients and their visitors to alert caregivers to a critical event was the right thing to do.
UPMC has a strong commitment to the use of rapid response teams. With the backing of the UPMC Center for Quality Improvement and Innovation, Condition C (for “critical”) and Condition A (for “arrest”) are now in use across the health system. While Condition A is standard in most hospitals, Condition C empowers any hospital staff member to signal a rapid response team when they see signs, such as difficulty breathing or a change in heart rate or rhythm, that a patient’s condition is deteriorating.
Condition codes traditionally have been activated by health care providers. Condition H is different: it asks patients and visitors to be part of the care team by alerting caregivers to clinical changes.
UPMC Shadyside Condition Help model
Questions and Answers
- What is Condition H (Help)?
- Why is Condition H needed?
- How do patients and visitors know
when to call a Condition H?
- How is Condition H activated?
- What is the Condition H decision tree for
hospital operators?
- Who responds to a Condition H code?
- How did UPMC begin the Condition H program?
- How did UPMC spread the Condition H program from
the initial pilot site to other hospital units?
- What kind of follow up does the hospital staff perform?
- What kind of Condition H calls do you receive?
- What are the outcomes of the Condition H program?
What is Condition H (Help)?
The Condition H (Help) program provides a hotline for hospital patients and their family members to call when there is:
- a noticeable, clinical change in the patient and the health care team is not present or not responding to the patient’s or visitors’ concerns
- a breakdown in how care is being managed or confusion about the care plan
Nurses educate patients about the Condition H program upon admission. Every Condition H call brings a rapid response team immediately to the patient’s bedside and includes a follow-up meeting the next day, which serves as a learning experience for the staff.
Why is Condition H needed?
- It provides another layer of safety to patients and families.
- It solidifies the care partnership among patients, families, visitors, nurses, and physicians.
How do patients and visitors know when to call a Condition H?
- Patients and their visitors are introduced the program at their port of entry to the hospital.
- Patients receive a tri-fold brochure about the program.
- Signs in patients’ rooms outline the program.
- Stickers on telephones contain the hotline number.
- Signs in public areas remind patients and visitors about the program.
How is Condition H activated?
- Patients or family members call the same emergency number that invokes UPMC’s other rapid response teams (Conditions A and C).
- The call can be made from any hospital telephone
- A trained hospital operator receives the call.
- The caller is instructed to provide the patient’s name, caller’s name, location, and nature of emergency.
- The hospital operator has a decision tree to help determine if pager and overhead alerts should be triggered.
What is the Condition H decision tree for hospital operators?
The decision tree is a tool hospital operators use to determine whether to activate the Condition H rapid response team or call the patient relations department.
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Operators activate Condition H pagers and overhead announcements:
- if a patient or visitor has a serious clinical concern, such as bleeding, difficulty breathing, or "something just isn't right"
- if a communication breakdown occurs, such as when a patient is confused about an invasive procedure
- if the reason for a call is unclear
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The patient relations department or administrative nurse coordinator is called, if a patient or visitor has an issue with any of the following:
- diet
- TV
- phone
- room temperature
- an empty water pitcher
- basic environmental concerns
- housekeeping concerns
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Who responds to a Condition H code?
The Condition H response team comprises:
- an internal medicine house physician
- an administrative nurse coordinator
- a patient relations coordinator
- a floor nursing staff member
How did UPMC begin the Condition H program?
The following elements were essential to starting the Condition H program:
- support for the program from hospital leadership, who communicated their support to hospital staff
- buy-in from medical staff and clinicians; although some presented reasons why the Condition H program should not happen, those reservations were overcome with experience with the program and open communication
- process redesign that began with small tests of change with actual patients and visitors on one unit
- a culture that values rapid response teams
- patience with inappropriate Condition H calls and persistence in getting to the reasons for those calls
- frequent communications (brochures, posters, wall signs, newsletter) about the program
Logistically, we began the program by conducting:
- patient interviews to help us understand their concerns
- staff in-service and patient education sessions, and communications to medical staff and hospital personnel to inform them about the program
- a mock Condition H with a real family
- a pilot program on a 24-bed medical-cardiology unit at UPMC Shadyside
How did UPMC spread the Condition H program from the initial pilot site to other hospital units?
- Hospital leadership and quality improvement specialists provided communication and in-service sessions to all inpatient units.
- Hospital physicians demonstrated their support for the Condition H program.
- Internal hospital newsletters helped us communicate details about the program.
- We asked caregivers who knew about the program to share information about it in every meeting, every forum, to every discipline, every day.
- Condition H was spread to all UPMC Shadyside inpatient units in July 2005.
- Condition H was implemented at Children's Hospital of Pittsburgh of UPMC in September 2005 followed by UPMC Presbyterian.
- The UPMC goal is that by January 2008, all UPMC acute care hospitals will offer patients and families Condition H rapid response teams as needed in critical situations.
What kind of follow up does the hospital staff perform?
The day after a Condition H code is activated, a patient relations coordinator visits with the caller to complete a questionnaire, which helps capture data about what initiated the call and how well the program addressed the caller’s concerns. This information helps to improve the Condition H program as well as to identify common precipitating events worthy of intervention by quality improvement specialists.
What kind of Condition H calls do you receive?
The majority of Condition H calls are made by actual patients or their family members.
| Reason |
2005 |
2005 Rate |
2006 |
2006 Rate |
2007 |
2007 Rate |
Totals |
Overall Rate |
PainManagement/
Medication Related |
1 |
10% |
15 |
42% |
13 |
52% |
29 |
40.85% |
| Communication Breakdown |
0 |
0% |
3 |
8% |
0 |
0% |
3 |
4.23% |
| Clarification of Orders |
1 |
10% |
1 |
3% |
0 |
0% |
2 |
2.82% |
| Psychological Issues |
3 |
30% |
0 |
0% |
0 |
0% |
3 |
4.23% |
| Discharge Planning |
1 |
10% |
4 |
11% |
1 |
4% |
6 |
8.45% |
| Medical Management |
2 |
20% |
3 |
8% |
5 |
20% |
10 |
14.08% |
| Diet Related |
1 |
10% |
0 |
0% |
0 |
0% |
1 |
1.41% |
| Dissatisfaction w/ Staff |
0 |
0% |
3 |
8% |
2 |
8% |
5 |
7.04% |
| No Data Reported |
1 |
10% |
7 |
19% |
4 |
16% |
12 |
16.90% |
| Totals: |
10 |
|
36 |
|
25 |
|
71 |
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What are the outcomes of the Condition H program?
90 percent of patients would call the Condition H hotline again if the situation arose.
Year one data / 2006
- 86 percent of patients felt their needs were met by the physician who responded to the code.
- 100 percent of patients felt their needs were met by nurses.
- 69 percent of Condition H calls potentially may have prevented events that may have resulted in a patient incident.