SHM Converge Scientific Abstract ePoster Gallery-Enhancing in-Hospital Patient Safety With the Epic Deterioration Index

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This poster describes a pilot implementation of the Epic Deterioration Index (DTI), an early warning score designed to predict inpatient deterioration 12–38 hours before clinical decline. The work addressed a common hospital safety problem: patients worsening in ways that are not always detected early by existing severity scores or rapid response systems, especially non-sepsis deterioration.<br /><br />The pilot was conducted on a 30-bed intermediate care step-down unit in an academic health system from November 2023 to March 2024. The implementation had three main features: a custom unit-level patient list with built-in documentation, charge nurse ownership of monitoring and intervention, and a non-interruptive design that avoided pop-up alerts and Best Practice Advisories.<br /><br />Results suggested limited adoption and weak workflow fit. Nurses generated 83 total alerts, but only 18 alerts (22%) had any subsequent documentation, with a median delay of 11.7 hours between alert and documentation. In a survey of 14 nurses, only 25% agreed that DTI predictions were accurate. Most nurses preferred a pop-up notification (79%) and all respondents wanted the predictions displayed in a different location within the EHR, such as the Nurse Brain, summary page, or unit manager view.<br /><br />Overall, the study found substantial challenges in both appropriateness and acceptance of the tool. The non-interruptive design and current placement of DTI information did not fit nurse workflow well, and the system’s ability to identify deterioration early remained uncertain. The authors conclude that future work should improve workflow integration and user-centered design, while also evaluating whether a custom early warning score can better detect inpatient deterioration and reduce preventable harm.

Asset Subtitle

Thomas F. Byrd IV

Meta Tag

Author List Angelica Willis, Evan Beacom, Julia Lister, Kiril Dimitrov, Molly Mattson, Thomas F. Byrd IV

Category Innovations

Concept Epic Deterioration Index

Concept Inpatient Deterioration Index

Concept Early Warning Score

Concept Alert Strategy

Concept Non-interruptive Alert

Distinguished Non-Finalist

Presenter Organization University of Minnesota

Presenting Author Thomas F. Byrd IV

Track Patient Safety

Keywords

Epic Deterioration Index

DTI

early warning score

inpatient deterioration

pilot implementation

step-down unit

nurse workflow

clinical decline

hospital safety

EHR integration

Epic Deterioration Index

Inpatient Deterioration Index

Early Warning Score

Alert Strategy

Non-interruptive Alert