For Hilo Medical Center, a 180-bed hospital and Level III Trauma Center in Hilo, a community of 43,000 on the Big Island of Hawaii, pursuing high quality standards directly aligns with their commitment to improving patient care.
“We are a big island, but we are a small community,” said Nicole Vergara, BSN, RN, Code Blue/Rapid Response Team Coordinator at Hilo Medical Center. “The people we care for are our friends, family and neighbors. We want to give the best care possible.”
After implementing high-performance CPR and Redivus Health resuscitation software over the last few years, Hilo Medical Center achieved significant milestones for cardiac arrest care in 2023:
- 40% survival to discharge rate after cardiac arrest – nearly double the national average.
- 100% compliance on all measures of the American Heart Association’s Get With the Guidelines®
- First review since the new resuscitation requirements from The Joint Commission were introduced, and Hilo Medical Center “met or exceeded standards and guidelines.”
A Path to Better Data
In 2017, Hilo Medical Center staff went through training on high-performance CPR, which led to improvements in resuscitations, but the quality data still did not support their outcomes.
“We knew we were doing a good job at resuscitation but capturing it with paper documentation was difficult,” Vergara said. “If we can’t capture it, we can’t prove it, and then we can’t improve where we need it. Nursing 101: If you didn’t document it, it didn’t happen.”
Vergara started looking for digital tools to help the team better document their work during a code blue and to prove their outcomes with data.
“I kept saying there’s got to be a better way. All this technology in the world, someone has to have figured this out,” Vergara said. “Other smart nurses and doctors have this same issue. This problem is not unique to us.”
Her search led to Redivus Health resuscitation/rapid response software with capabilities for real-time documentation, ACLS/PALS guidance, and automated analytics. Hilo Medical Center implemented Redivus code blue software in October 2022, which included integrating the software with their EHR.
“Before, with paper documentation, it wasn’t easy for the scribe to capture everything in real time,” Vergara said. “We had incomplete records, inconsistent timing. Some things we could not capture at all, such as CCF (chest compression fraction) rate or time on the chest. Without the data and times, we could not make that calculation.”
“Now with Redivus, we have an increase in capture of data, an increase in accuracy, and an increase in reporting,” Vergara continued. “I’m seeing data that represents the codes I’m experiencing, rather than missing some elements of documentation. Data is powerful – it can guide us. But it has to be meaningful, and it has to be accurate.”
Presenting Data to The Joint Commission
In 2022, The Joint Commission introduced new resuscitation care standards for all hospitals and critical access hospitals accredited by the organization. Hilo Medical Center’s first assessment by The Joint Commission since the release of the new resuscitation requirements and its first using Redivus resuscitation software was in May 2023. The Hilo team went into the survey confident in their resuscitation data.
“Previously, with paper records, we would have some missing information, but Redivus changed that – it was a huge plus,” Vergara explained. “We could prove that we were meeting quality measures: time to first compression, time to first shock, time to first epinephrine on various resuscitations. The most impressive quality measure is that we could prove we were staying on the chest. We had definitive data so we could prove that we weren’t delaying care or having excessive times off the chest.”
Instead of spending hours pulling data from various sources and building manual reports, Vergara used the Redivus analytics dashboard to report cardiac arrest data quickly and easily. The Hilo team also uses these automated reports for debriefs immediately following a code and in monthly Code Committee meetings.
“We showed The Joint Commission the Redivus dashboard with data that indicated the percent of patients resuscitated vs. deceased, how many events were happening, where they were happening – all things The Joint Commission outlined in the 2022 R3 Report that we should be recording and measuring,” Vergara said.
The Joint Commission’s surveyor for Hilo Medical Center concluded: “We have no advisement. You’ve met or exceeded standards and guidelines for this area.”
Proving Performance with Data
In addition to the exceptional result of meeting The Joint Commission’s new standards for resuscitation, Hilo Medical Center earned the American Heart Association’s Get With The Guidelines® Resuscitation Gold Award for 100% compliance on all measures for their 2022 resuscitations.
“With the data that came from Redivus, we were able to report our code blue and rapid response rates,” Vergara explained. “They (AHA) were super impressed that our code blue survival to discharge rates were 40%, which is double the national average. These are people going home with intact mentation, meaning they are thinking and functioning as they did before cardiac arrest, they are not going to a long-term care center.”
Having accurate data and external recognition supports Vergara in leading the Hilo Medical Center team to continue improving their life-saving skills.
“Data shines a light on things – it gives people a voice to ask for more training or education,” Vergara said. “I feel like this is the best thing Hilo Medical Center has spent money on. We have made an investment of time and money to improve our performance and care during the scariest emergency anyone could face in our community.”
Hilo Medical Center has worked hard to transform resuscitation care, achieving resuscitation outcomes that far surpass the national average. With the help of high-performance CPR and Redivus code blue/rapid response software, Hilo Medical Center has elevated its resuscitation outcomes and the ability to document and prove its performance with accurate data.
“Although our documentation still isn’t perfect, it’s significantly better since we adopted Redivus. Our codes look more like what’s actually happening in the room than the papers ever did,” Vergara said. “We’re not perfect. We’ll never be perfect, but we keep striving for better.”