Early detection of critical illness outside the intensive care unit: Clarifying treatment plans and honoring goals of care using a supportive care team

Given the high mortality experienced by patients who deteriorate outside the intensive care unit, issues related to patient preferences around escalation of care are common. However, the literature on early warning systems (EWSs) provides limited information on how respecting patient preferences can be incorporated into clinical workflows. In this report, we describe how we developed workflows for integrating supportive care with an automated EWS in the context of a 2-hospital pilot. We used the Institute for Healthcare Improvement's Plan-Do-Study-Act approach to achieve consensus with clinicians and administrators. The workflows will serve as the basis for dissemination to an additional 19 hospitals. We were successful in integrating an automated EWS with supportive care. Our workflows take local resource availability into account and have been well received by hospitalists, nurses, and families. Our work demonstrates that one can achieve integration of proactive supportive care into the operation of an EWS. Creation of a palliative care response arm that is complementary to a clinical rescue arm ensures that patient preferences are respected. Journal of Hospital Medicine 2016;11:S40-S47. © 2016 Society of Hospital Medicine.