Early warning system for hospitalized patients

The Kaiser Permanente Division of Research led the development of the Advance Alert Monitor (AAM) that provides early indication that a hospitalized patient might experience a decline in health status. The researchers used data from 1.5 million Kaiser Permanente patients to develop a severity score that is coupled with real-time patient data to quantify risk of rapid deterioration. Our integrated system enabled the establishment of an efficient workflow to manage the alerts as they are generated. Highly trained nurses from a virtual quality team review the alerts for patients in up to five Kaiser Permanente hospitals. The nurses then work with the rapid response team at the patient bedside to adjust the patient’s care plan to reduce the risk of deterioration. A study published in the New England Journal of Medicine found that AAM was responsible for preventing 520 deaths per year, in addition to reducing ICU admissions and length of hospital stays. This new clinical practice leverages our extensive data, our connected healthcare system, and team-based care to lead to better clinical outcomes for our patients.^[1]

Lower risk of premature death

Kaiser Permanente leads the United States in cancer screening. And while detecting cancer early can lead to better outcomes, a recent study from our Southern California region in The American Surgeon shows that across cancer stages, Kaiser Permanente patients with colon cancer had better outcomes, including a 25% lower mortality rate compared to other insured patients. Aspects of integrated care that support our approach to cancer care include standardized electronic health records, emphasis on adherence to national clinical guidelines on cancer treatments, and care coordination across all medical departments. This study also noted that while in the United States, higher socioeconomic status leads to better outcomes, at Kaiser Permanente Southern California, there were no disparities related to socioeconomic status.^[2]

Reduced post-surgical complications

Around 25% of all surgery patients across the United States suffer postoperative complications. Kaiser Permanente physicians in Northern California wanted to reduce these complications and decided to develop a protocol using the Enhanced Recovery After Surgery (ERAS) protocol.^[3] This was initially developed in Northern Europe, and features a team-based approach used before, during, and after surgery. While this has been used for more than two decades, and has been shown to reduce hospital stays, Kaiser Permanente wanted to evaluate whether this protocol could reduce complications such as cardiac, pulmonary, and neurologic problems. Key components of the protocol are encouraging patients to eat food 8-12 hours before surgery and provide a high carbohydrate drink a few hours before surgery, as opposed to fasting.^[4] The care team uses non-opioid pain relievers and encourage patients to walk within 12 hours of surgery. They also work to lessen patients’ anxiety by providing clear information about the surgery and recovery and encourage active participation in recovery.

Results from the study showed a decrease in opioid prescribing rates of 21% and early mobility, which helps prevent blood clotting and pneumonia, increased 34% for colorectal resection patients and 18% for hip fracture patients. These results were enabled by implementing clear clinical pathways that guide care teams and patients through preoperative planning, surgery, and recovery.^[5]

Kaiser Permanente continues to evolve and innovate to respond to the dynamic nature of providing healthcare. As we face the systemic healthcare challenges experienced by many, our approach to integrated and value-based care provides a solid foundation to continue to improve outcomes and patient experience, reduce costs, and drive towards more equitable care.