NIV provides a range of symptomatic benefits and maintains patients in the community with a reasonably good quality of life. To ensure a high level of care and patient satisfaction, several service areas warranting further development were identified. Our results should help promote this highly effective therapy and aid the development of Australasian NIV service guidelines.

Background: General patient acuity is increasing in the United States, with more patients having multiple comorbidities and acute-on-chronic conditions. Hospitalizations may also be complicated by serious adverse events, often unrelated to the admitting medical diagnosis. In our facility, the late detection of patient deterioration on general medical units often resulted in increased length of stay (LOS) in the ICU and poor patient outcomes. Purpose: The purpose of this project was to improve patient surveillance and better identify early signs of patient deterioration through the use of continuous vital sign monitoring technology. Methods: To improve detection of patient deterioration, a nurse-led monitoring and response system was developed using a wearable, wireless device for continuous vital sign surveillance. The patient data the device provided was used with early warning scores and sepsis screening protocols for timely goal-directed interventions. Results: Ninety-seven percent of patient deterioration events were recognized and treated as a result of this continuous monitoring and response system. Rapid response team activations decreased by 53% between baseline and the intervention period. LOS among patients transferred to the ICU decreased from 2.82 to 2.19 days. Nurse satisfaction with use of the continuous monitoring device was positive, with 74% of nurses surveyed reporting that information provided by the device enhanced decision-making. Conclusions: New technology for patient surveillance, in this case a nurse-led monitoring and response system, can be successfully integrated into general care practice. Use of the nurse-led response system helped nurses recognize early signs of deterioration and continue meaningful patient interactions.

Background: Inpatient nurses identified the need to recognize clinical deterioration earlier, including rapid response team (RRT) activations and transfers to the intensive care unit. Surveys identified the need for better interdisciplinary communication. Local Problem: A system was needed to detect early clinical deterioration with structured responses promoting multidisciplinary collaboration. Methods: An early warning score (EWS) identified patients at risk. The system ensured timely and accurate actions were taken when scores reached 3 or above. Interventions: Collaborative, graded responses to EWSs and nurse-led rounds promoted communication and timely interventions. Results: Mortality decreased (−27%) as did multiple RRT activations on a single patient (−15%). Nurses are aware of early vital sign changes (+45%) and resident responsiveness has improved. There has been an increase in nurse/resident communication satisfaction (+31%). Conclusions: The system implemented reinforces the importance of patient assessment, collaboration among the multidisciplinary team, and promotes early interventions.