Rochester General Hospital
Rochester, New York, USA

Team

Mary Lu Daly, MS, RN, CCRN, Clinical Nurse Specialist
Jeanne Powers, MS, RN, CCRN-CMC, Clinical Nurse Specialist
Vicky Orto, MS, RN, CNAA, BC, Director of Medical Nursing

Aim

The aim of the Early Nursing Intervention Team (ENIT) program is to decrease the number of codes on general care units by 50 percent in the first year and by 75 percent in the second year of the program.

Measures

• Number of codes

Changes

An Early Nursing Intervention Team (ENIT) is a program that goes above and beyond the Rapid Response Team concept. In addition to responding to calls from general care units concerning a patient’s clinical deterioration, the ENIT program includes twice daily rounding on all general care units by an experienced intensive care unit (ICU) nurse.

• Initiated twice daily rounding on all general care units, including educating staff about the ENIT program and addressing any patient/clinical issues to include the Situation-Background-Assessment-Recommendation (SBAR) concept.
• Developed system of paging/calling ENIT nurse at the floor nurse’s first concern for a patient.
• Established activation criteria for ENIT calls.
• Obtained budgetary approval to increase RN staffing complement in the ICU to accommodate the ENIT program, thus ensuring that the ENIT nurse is able to round twice daily on ten inpatient units.
• Provided pre-implementation education to all nursing staff.
• Communicated the concept and purpose of the ENIT program to all medical staff.
• Implemented weekly planning meetings prior to ENIT program inception.
• Continued regular meetings to provide feedback about the ENIT program and share lessons learned.
• Established regular meetings with key medical staff and the Chief of Medicine.
• Established follow-up call to general care units to track progress of patients seen by the ENIT nurse.

Results

Summary of Results / Lessons Learned / Next Steps

Since the introduction of the ENIT program, there has been a dramatic reduction in codes occurring on general care units.  Comparing the number of codes over a two-year period has revealed a marked reduction of codes on general care units. In the first seven months of ENIT program implementation, 13 codes occurred compared to 26 codes in the same time frame one year prior to implementation.

• Ensure communication to all involved staff: nursing and medical staff at all levels – from the staff nurse to the off-shift nursing supervisors to the Chief Nursing Officer – from the first year resident and mid-level providers to the attending physicians.
• Involve all key stakeholders from the onset and follow-up with them as needed.
• Feedback through both formal and informal routes has led to changes in the program and to hospital-wide implementation.
• Develop teams that are a good fit for your institution – our nurse-led teams work for us, but may not be the best model for other institutions (sometimes a very creative approach can work; persevere when criticized).
• Advertise your success; use exemplars.
• Continue to grow and develop the general care staff towards the goal of increasing independence from the critical care staff.
• Prepare for an influx of experienced nurses from your general care units ready to transfer to ICU.
• Avoid turf wars; promote collegiality.
• Provide regular oversight through regular meetings with the ENIT nurse team to ensure consistent program implementation.
• Twice daily rounding has led to side benefits of increased collegiality and recruitment of experienced general care nurse to our ICU.
• ICU staff vacancy rate has dropped dramatically from a high of 36 percent in early 2004 to 13 percent in early 2006.

Contact Information

Mary Lu Daly, MS, RN, CCRN 
Clinical Nurse Specialist
Rochester General Hospital
marylu.daly@viahealth.org