Bill Klaproth (Host): This is a special episode of Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. Recorded live at the AONL 2024 conference.

I'm Bill Klaproth as we talk about Innovative Rapid Response via Nursing Expertise and Predictive Analytics. With me, we have Carol Tierney, Associate Chief Nursing Officer at the Christ Hospital Health Network. Patrick Kokotek, Staff RN, MICU and Rapid Response Team Lead at the Christ Hospital Health Network. And Julie Holt, Chief Nursing Officer and Vice President of Patient Care Services at the Christ Hospital Health Network. I want to welcome you all today. Carol, welcome.

Carol Tierney, PhD, RN, NEA-BC: Bill, it's great to be here. Thanks for having us.

Host: Thank you, Carol. Great to see you. Patrick, it's so good to see you.

Patrick Kokotek: Thank you. Thank you. Thanks for having us. Appreciate it.

Bill Klaproth (Host): Looking sharp today. I know it's a podcast. Patrick, I think, gets the Best Dressed Man Award today. Look at

Carol Tierney, PhD, RN, NEA-BC: Woo hoo.

Host: Look at this fine gentleman here. My goodness. And we also have with us as well, Julie Holt. Julie, welcome.

Julie Holt: Thank you. Great to be here.

Host: Yeah. Great to have you all here. So let's talk about your session. This is very interesting. Patrick, tell us about your session. And your innovative rapid response strategy and why you wanted to address this at AONL 2024.

Patrick Kokotek: Yeah, absolutely. So, back in 2017, we had a rapid response team that was a little bit from get go, just not necessarily where we wanted it to be. We had some growth opportunities that we really saw that we could improve on. And so we took the initiative underneath ourselves to really improve what we were doing and how we could improve patient outcomes.

So with that, um, we've made some quality eight, eight ish changes to our program that really, helped improve those outcomes that we were having. And, I know we'll get on it a little bit later, but some of those outcomes were pretty impressive that that's why we were here at AONL to share those things.

Host: Yeah. So eight ish initiatives. Can you kind of share with us some of the eight ish?

Patrick Kokotek: Yeah, absolutely. So, the first step is what we're calling preemptive rounding. Actually even before that, we pulled out an FTE. So we had a staff nurse now individualized for our rapid role. Originally it was part of our medical ICU charge nurse role. And so we pulled that aside and made it separate.

And that was step one. Step two was the preemptive rounding. So from that, that one nurse walked around the hospital, they rounded, they found patients that they needed. They talked to nurses. They collaborated with everyone to get that going. Number two was our code stroke program. We saw a growth opportunity with that.

And we felt like we could do a better response time with that. And we did. It was very nice. Outside of that was our chest pain algorithm, very similar. We were missing some of our STEMI data, marks. And we were able to achieve better results with that, working with our cardiology team. From there we did a code narrator program that helped basically standardize how we were charting our codes.

That's part of our initiatives. I lost count so I'm going to go to my favorite one. And that one is our deterioration index scores that we worked with EPIC in our EMR system. And with that, that is a predictive analytic piece. That's where this whole AI process comes into it. And it basically determines how likely you are to deteriorate, transfer to an ICU, code, or meet your demise. And that's one of those things that it's always scary to hear, but it was a very, very accurate in our opinion predictive analytic piece that we as the rapid response team could see, Hey, this patient's deteriorating. What can we do to help fix that and stop it and halt it?

Host: Patrick, thank you for that. I love all those. So Julie, let me come to you as the CNO and for someone that wants to duplicate what you did or take inspiration from you, what's important to know and how important is it to have leadership buy in?

Julie Holt: It's incredibly important to have leadership buy in. And, I think not just at the CNO level, but at the organizational level. For us, we knew that our electronic medical record vendor was beginning to use this technology of predictive analytics for patients. And we knew at the same time that there was some opportunity with our rapid response team. So, I think pulling that together and being able to find the FTEs to cover that and make change and show the return on investment was really important and it was, part of the project.

Host: Absolutely. Carol, let me get your thoughts in on this on what you've done with Patrick and Julie have said. Your thoughts.

Carol Tierney, PhD, RN, NEA-BC: Thanks, Bill. My role is sort of advocating for the direct care nurse at the bedside to have a voice and Patrick has done so much of this work independently. While he does have clinical responsibilities, he's the voice and the face of our rapid response team. So, to hear him talk about deterioration index and talk about rounding on patients and improving the patient care, it was my goal to try and find a conference where we could highlight Patrick and the great work occurring at the Christ Hospital. So I'm like the cheerleader.

Julie Holt: Right.

Host: Yeah, you've come to the right place.

Carol Tierney, PhD, RN, NEA-BC: Yes.

Host: Yeah for sure, Julie?

Julie Holt: I, would just like to throw in too, the AONL program, Care Innovation and Transformation, I think was really instrumental in helping us with this program or with this particular initiative because we brought our staff nurses together with our leadership to learn about a small test of change, process improvement, and really having the front line engaged in performance.

And so, turning it over then to the front line to let them really make that difference. It's huge and it's such a great product. And then giving people the permission to try things and fail and risk take, calculated risk. It was something we learned from the AONL program CIT and it was great.

Host: Yeah well thank you for sharing that, so Patrick, tell us about the results. What's the outcome of all collectively your efforts but apparently you're sort of driving the bus here. So tell us the results of your efforts.

So first i

Patrick Kokotek: have to give better thanks to Julie and Carol. They actually started this process, so I do want to not underscore what they definitely helped me with, so thank you ladies. Our outcomes were unbelievable, so our biggest piece that we were loving to share, is that our outside of the ICU code blue numbers are down by almost 40%. And so that's obviously not just due to our passions, but we're taking a lot of the credit for it.

Um, and a lot of that is to, we're putting our patients in the right, with the right spots. So when we find patients who might not be in the ICU, but need to deserve to be there, their health deserves to be there; we're getting them in the right spot so that they can get the care that they need with the nurse ratios that they need, with the equipment that they need.

Like I said, that 40% down is just unbelievable. At the same time, our rapid response calls have been more than doubled. So, a little data to share. So, back in 2013, I believe we had like about 700 rapid response calls in that year total. And then in 2020 when we were really up and running, we hit 2,500.

We've drastically increased it and I believe just in 2023, we hit the 2000 mark again. So it is one of those pieces that we're getting contacted more to help our bedside nurses outside of the ICU, really to give these patients the care that they need and deserve. And being able to lay that critical care eye outside of the ICU has just improved our patient outcomes drastically.

Host: I'm curious, what did you learn along the way? Did anything you learn suprise you?

Patrick Kokotek: Oh my gosh, it's so much, so unbelievably much. So I am not, I mean, I guess I can call myself a leader at this point, but when I started I was not. I was working night third shift, I was coming in occasionally, I maybe got eight hours a month to really work on just individually this rapid response program to dedicate to it.

And now I would say I spend most of my time just doing this piece or in the actual role itself, still being at the bedside doing that. I've learned an incredible amount from these ladies and my manager in the medical ICU, I'm going to name drop Amy Connors. She's an amazing person and just did a great job, um, with some, guided autonomy is what I'll call it.

She really was able to, just tell me what she thought I needed to do. But like Julie kind of mentioned, allowed me to make mistakes, allow me to fail a few times. Carol did a great job and taught me how to just cold call people. I was, calling John Hopkins University. I called Duke University, Stanford University hospitals, all these areas just to try and get what they were doing and see if it worked with what our program was going and see where we were going with it.

And that is the leadership skills that I've learned through this five year process that are just invaluable. I will never be able to gain that knowledge outside of any other program and that's where I truly believe this has come.

Host: Amazing. Carol, what, anything that surprised you or, things that you learned that you thought, wow, this is interesting?

Carol Tierney, PhD, RN, NEA-BC: What I found pretty cool, Bill, is going through the pandemic when everyone was tired and working really hard that Patrick was still able to continue to grow this program knowing that patient outcomes matter and we need to keep that at the forefront. So despite how tired and pulled into staffing he was, the momentum of this project just kept going and the data shows the impact that the rapid response team is having on our patients.

So that's so cool to me. And as we come out of the pandemic, knowing that people are starting to get their energy back, to see more work like this from our leaders at the bedside is something that I'm really excited about.

Host: Yeah, I love that. And Julie, how about from your perspective?

Julie Holt: I think for me as a leader, a lot of times, we feel like we have to have the answers to all the problems that are out there. And what I've learned through, I've been doing this for over 30 years, but especially, in my last eight years at the Christ Hospital, is that if you put the problem out there, give people the tools and the resources; they will blow you away with what they're able to accomplish and far exceed any expectation that you have and and it's so exciting to watch and to see and you're just able to get so much more done for our patients, which is really our focus.

Carol Tierney, PhD, RN, NEA-BC: And a gift that we have is, Julie Holt, and I mean this. She, as Patrick said, she allows us to fail. Try it. If that doesn't work, this is something that she frequently says. You know, and not a lot of CNOs are like that.

Julie Holt: Calculated risk, yes.

Host: Calculated risk. I love that. Well, before we wrap up, I'd just like to get final thoughts and observations from each of you. Carol, let me start with you. Anything additional you want to add?

Carol Tierney, PhD, RN, NEA-BC: For people listening, I want to encourage you to put out there the work that you're doing. Because some other organization that doesn't have the resources that your organization has can learn from you. So, take a chance. Put together an abstract and try to go to a conference and share the work that you're doing.

I think a lot of people would be interested in what's occurring at a lot of hospitals across the country today.

Host: Yeah, that's great. And Patrick, you've obviously poured yourself into this whole project. Final thoughts? Anything you want to add?

Patrick Kokotek: I do definitely want to give a lot of credit to the team that we work with the Rapid Response. So our actual Rapid Response nurses that are in and out of there, the education that they provide for the floor nurses, their in and out 24/7 care that they give is truly unbelievable and so a quick shout out to the Christ Hospital Rapid Response team nurses.

Host: Yeah, amazing. And Julie, as we wrap up, final thoughts from you?

Julie Holt: Just wanted to say thanks to the entire Rapid Response Team and our leadership team at the Christ Hospital. We have such a great group of people working together, embracing these principles. And thanks to AONL for coming in and doing care innovation and transformation back in 2019 for us. I think pulling our whole organization together and teaching everyone the language and the tools really made a difference in implementing things at the frontline and engaging the frontline staff in that for our patients. So, thanks.

Host: Yeah, well said. Well, thank you each today. We really appreciate your time. Thank you so much for stopping by.

Carol Tierney, PhD, RN, NEA-BC: Thanks Bill.

Julie Holt: Thanks

Patrick Kokotek: Bill thanks for having us.

Host: You bet. Once again, we have Carol Tierney, Patrick Kokotek and Julie Holt. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

This is Today in Nursing Leadership. Thanks for listening.