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Rapid Response System Empowers Patients And Families To Seek Help

Program reduces chance of errors, improves patient satisfaction at UPMC Shadyside

PITTSBURGH, November 6, 2006 — A unique system that empowers patients and their families at UPMC Shadyside to call for help from “rapid response teams” is reducing the likelihood of medical errors and maximizing patient safety, says an article in the November issue of the American Journal of Nursing. Condition H, as this innovation at the University of Pittsburgh Medical Center (UPMC) is called, involves patients and families in a true partnership with health care providers.

“Condition H takes the concept of patient-centeredness and puts it into practice in a unique and effective way,” says Pamela K. Greenhouse, the lead author of the article and associate to the vice president at UPMC’s Center for Quality Improvement and Innovation (CQII).

For years, many hospitals, including UPMC Shadyside, have been responding to in-hospital emergencies with designated teams of doctors, nurses and other staff. But these teams can generally be summoned only by health care providers. Condition H acknowledges that patients and families may recognize signs that a patient is deteriorating before physicians and nurses do.

The catalyst for Condition H -- now in use at UPMC Shadyside and Children’s Hospital of Pittsburgh of UPMC -- was the tragic death in 2001 of 18-month-old Josie King at Johns Hopkins Medical Center in Baltimore. Hospitalized for burns suffered in a bathtub accident, Josie was only days away from returning home when she died from severe dehydration and misused narcotics. At the Institute for Healthcare Improvement’s national forum in December 2004, Josie’s mother, Sorrel, spoke about the devastating errors and the unheeded alarms that led to her daughter’s death. She proposed that patients and families be able to initiate a call to rapid response teams, such as those that now respond to cardiac and respiratory arrests at some hospitals.

Tamra Merryman, then vice president of patient care services at UPMC Shadyside, was in the audience and immediately brought King’s idea back to Pittsburgh. Condition H (for “help”) was started at UPMC Shadyside in May 2005, the first such program of its kind in the country. “We shouldn’t put you in a hospital and take away your right to call 911,” says Merryman, a co-author of the article and now vice president of CQII.

When patients are admitted to UPMC Shadyside, they receive guidelines for calling a Condition H and a phone number for activating the team, which includes a physician from internal medicine, patient relations coordinator and unit nursing staff. Additional clinical support is called in as needed. Patients and families are instructed to call a condition H if a noticeable change occurs in the patient but the health care team doesn’t appear to be responding to the change or to the family’s concerns; or if there is a breakdown in how care is being given or confusion over what needs to be done for the patient. The goal is to involve families more substantially in care to minimize the likelihood of errors.

Most of the 21 Condition H calls in the first nine months met at least one of the criteria, according to the article. Many were related to communication issues between patients and clinicians. For example, one patient had concerns about receiving a blood transfusion and felt that the physician had not adequately explained the need for it. In other instances, the patient and family disagreed with the treatment or care but didn’t believe that their concerns were receiving enough attention. Five of the 21 calls were related to the need for more effective pain management. Although none of these early calls has definitively saved a life or averted a serious medical crisis, Condition H may do so in the future, says Greenhouse. Patients and families involved in the calls have all expressed favorable responses toward the program, the article notes. “Having Condition H available makes me feel safer, respected and empowered,” said one participant.

The American Journal of Nursing is the oldest and largest circulating nursing journal in the world. Along with Greenhouse and Merryman, M.S.N., R.N., the authors of the article are Beth Kuzminsky, M.S.N., R.N., staff associate at CQII, and Susan C. Martin, M.S.N., R.N., director. The King family has provided monetary support for Condition H programs at UPMC Shadyside and elsewhere. For more about the Josie King Foundation’s work promoting patient safety, go to .

About UPMC and the Center for Quality Improvement and Innovation

The University of Pittsburgh Medical Center (UPMC) is the largest integrated health care enterprise in Pennsylvania and one of the leading nonprofit medical centers in the country. It is one of only 14 hospitals nationwide to earn “honor roll” status in U.S. News & World Report’s 2006 “America’s Best Hospitals” survey. Widely recognized for its innovations in patient care, research, technology and health care management, UPMC is the largest employer in western Pennsylvania, with 43,000 employees and nearly $6 billion in revenue. UPMC comprises 19 hospitals, 400 outpatient sites and doctors’ offices, retirement and long-term care facilities, an insurance plan and international ventures. For more information, go to .

In pursuit of the highest quality patient care, UPMC has established the Center for Quality Improvement and Innovation. This group of doctors, nurses and administrators leads UPMC hospitals in discovering opportunities and setting priorities for patient-centered innovation and quality improvements.

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