Cardiogenic Shock Team Cuts Time to Diagnosis by Half

A cardiovascular specialty hospital in north Texas decreased time to diagnosis for patients with cardiogenic shock by more than half, according to a study published in Critical Care Nurse (CCN).

Baylor Scott & White The Heart Hospital – Plano, a 105-bed cardiovascular surgical hospital in north Texas, developed a multidisciplinary shock team as part of its efforts to improve outcomes for patients experiencing cardiogenic shock. The condition is an infrequent complication of ischemic heart disease, and more than 80% of incidents of cardiogenic shock occur after an acute myocardial infarction. Shock teams aim to improve timely recognition of the signs and symptoms, and then facilitate care among specialty physicians, nurses and other healthcare professionals.

A retrospective review of internal data demonstrated that the newly implemented shock team was not yet impacting patient outcomes. The analysis also revealed inconsistencies that could delay recognition of patients with cardiogenic shock.

“Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation” details how a nurse-led quality improvement initiative at the hospital significantly improved the time from first signs to diagnosis for patients already admitted and the time from the initial transfer request to acceptance for patients being transferred from a referring hospital.

Co-author Suzanne Krais, DNP, RN, NEA-BC, CCRN, is the hospital’s chief nursing officer and vice president of patient services.

“Rapid response teams have been crucial for patients with rapidly declining conditions or sudden changes in status, but many patients with cardiogenic shock have gradual physical changes over several hours or even days,” she said. “Nurses play a pivotal role in activating shock teams by providing initial assessments and recognizing trends in patients with complex medical conditions. Through this initiative, we developed specific tools to help nurses and other clinicians know when to escalate a patient’s treatment to the shock pathway.”

Educating the nursing team was one of the primary elements of the initiative. The hospital system’s shock consortium developed an algorithm to assess and treat patients with cardiogenic shock. Using the acronym SALUDE, the algorithm guides nurses and other clinicians in identifying the signs of cardiogenic shock and through the various steps of activating the shock team.

Educational opportunities took 15 to 30 minutes via in-service training, new hire orientation, daily huddles and monthly unit meetings. All shock team members received one-on-one education that reinforced their specific responsibilities on the team.

The initiative also developed a one-call emergency alert specific to the shock team, using the Everbridge communication platform. In addition to sending a HIPAA-compliant message via email and text messages, the platform retains data about the alert that can inform later review. The team used the information to create a database for metric assessment, process improvements and benchmarking.

For this study, the analysis looked at preintervention data for 25 patients admitted between April and May 2021. The postintervention data included 45 patients admitted in April and May 2022.

The mean time to diagnosis decreased significantly, from nearly 18 hours to 8.15 hours.

For patients with cardiogenic shock transferring from a referring hospital, the median time to acceptance fell from 1.55 hours to 0.35 hour.

The analysis indicated no differences in mortality, use of mechanical circulatory support, length of stay or length of time receiving mechanical circulatory support between the two groups, likely because of the short time period and small sample size.

As a result of the initiative, the hospital now participates in the national cardiogenic shock registry created by the American Heart Association to standardize care, increase collaboration and obtain benchmarks.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of about 130,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

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