Just a few months into a phased rollout of the Christiana Care Early Warning System, its developers within the Value Institute are receiving positive feedback from frontline health care providers.

CEWS, an innovative system designed by Christiana Care, provides a standardized measure of patient acuity that helps proactively identify patients who are at risk of or are currently deteriorating physiologically, to support their timely care and improve outcomes. The system, developed by the Christiana Care Value Institute in collaboration with the Acute Medicine Service Line, Nursing, Information Technology and the Office of Quality and Patient Safety, captures real-time electronic patient information and visualizes acuity by using CEWS values and trends. CEWS triggers real-time alerts then gives care providers relevant information about patients’ current CEWS values, including 24-hour score trends and clinical recommendations.

“CEWS is the second pair of eyes watching out for our patients,” said Sherry Zurlo, MSN, RN, PCCN, from the 6S stepdown unit at Wilmington Hospital. “It’s been great to have that added layer of protection for them, sometimes picking up on subtle changes I might have missed otherwise.”

CEWS has been operational since May 30 in five inpatient units at Christiana and Wilmington hospitals.

“The feedback we’ve received from frontline providers is positive,” said Muge Capan, Ph.D., associate director of health systems optimization for the Value Institute. “Nursing and providers use CEWS in their communication and utilize it as a clinical decision support tool.”

Although data analysis still is under way, anecdotal evidence from pilot units using CEWS is positive.

For example, frontline providers have shared that they like seeing the CEWS value as an additional piece of clinical information that can help to alert the team when a patient might need increased observation.

The rollout also has identified some opportunities to improve the system, Capan said, including adjusting alert frequency, modifying the system for chronically ill patients and educating staff outside the pilot units about CEWS. Ensuring the effectiveness of alerts while guarding against “alarm fatigue” — the desensitization and reduced response that can happen when alarms are too frequent — has been an important area of focus throughout the project’s design. A multidisciplinary team of clinicians including the Evidence Based Nursing Practice Council, health information technology experts, industrial engineers and human factors experts assessed this issue by developing and evaluating three different alert frameworks based on historic data.

Additionally, the team identified opportunities to clarify and standardize some nurse screening assessment elements to potentially enhance their usability and interpretation to better predict patient deterioration.

The team also identified opportunities for staff education about CEWS in relevant areas outside the pilot units to enhance awareness. For example, the team identified the need for expanding distribution of CEWS education to raise awareness in certain procedure-based locations, such as dialysis. Since a patient’s location does not change in the electronic health record when he or she is temporarily off their unit due to dialysis procedures, CEWS alerts and tasks can fire while the patient is outside of the CEWS pilot unit receiving dialysis.

The team is collecting and analyzing feedback and patient data, including outcomes from the pilot units, which will inform the next steps in the phased rollout. CEWS will gradually be expanded to medical, surgical, stepdown and rehabilitation units.

Four interdisciplinary working groups comprised of clinicians, investigators and employees in information technology, education, nursing, and quality and safety, are working on CEWS implementation under the guidance of the Committee for Acute Medicine and Early Recognition of Adverse Events (CAMERA) and executive sponsorship of the Clinical Value Council Executive Committee.