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The ART Program: Equipping Nurses with Critical Skills to Anticipate and Respond to Patient Deterioration

July 6th, 2023
July 6th, 2023

This blog was taken from a recent HealthStream Webinar entitled “The ART Program: Equipping Nurses with Critical Skills to Anticipate and Respond to Patient Deterioration”. The webinar featured Dr. Dan Davis, Founder of the ART Program and Chris McElvogue, BSN, RN, HealthStream’s Director of Product Management.

The webinar focused on the ART Program and how it can enhance efforts to address clinical deterioration while also reinforcing critical thinking skills among nurses, and other providers with tools and resources, and the expertise required to anticipate and intervene when deterioration is detected.

 

The ART Program and Preventable Death

Dr. Davis began by sharing that the program is the result of his work at the University of California San Diego. Dr. Davis had oversight for the Code Blue and Rapid Response teams and the ART program grew out of his work on those teams. The program was remarkably successful in both reducing the number of cardiac arrests and increasing survival rates. As the program was duplicated and implemented at other institutions, they too had similarly impressive success rates. 

Dr. Davis shared that while estimates can vary somewhat, the best available literature suggest that there are about 400,000 preventable deaths each year in the U.S., representing between one third and one half of all deaths that occur in hospitals. Traditional care models have resulted in some variability in such factors as when the nurse is aware of the patient deterioration, when the physician is aware of patient deterioration and when an intervention begins. Ideally, that intervention comes well before cardiac arrest, but it does not always happen that way.

The ART program focuses on eliminating the barriers to early intervention. Dr. Davis pointed to factors such as a shortage of nursing staff, a decreasing number or experienced nurses, frequent handoffs, and staff that may feel too intimidated to voice their concerns as contributory to causing delays in early intervention.

While Dr. Davis feels strongly that no one should die before they are done living, he also points out that these preventable deaths have a cost to healthcare organizations in lost reimbursements due to pay for performance regulations, legal issues, poor public perceptions of the organization, and eroding staff morale.

 

The ART Program – It is Very Clear That It Works

When implemented at other institutions, the results of the program have been remarkably consistent. Dr. Davis has seen that hospitals that have implemented the ART Program have consistently seen a doubling or tripling of cardiac survival rates, while significantly reducing the number of cardiac arrests. 

“If the impact of the ART Program at UC San Diego could be replicated across the United States, we would save 383,00 lives each year,” said Dr. Davis. He also pointed out that this could be accomplished by simply using a different approach to education and ultimately to nurse empowerment.

 

The ART Program – How It Works 

Dr. Davis explained that a solid understanding of physiology is essential to recognizing the signs and symptoms of deterioration. He also stressed that the program really emphasized comprehension over memorization and focused on the kinds of critical thinking skills that are essential to early recognition of deterioration and the development of an appropriate intervention.

Dr. Davis shared that there are four pathways to clinical deterioration that can lead to cardiac arrest:

  • Circulatory Pathway
  • Dysrhythmic Pathway
  • Respiratory Pathway
  • Neurologic Pathway

In addition, Dr. Davis identified 15 clinical diagnoses that can lead down one of the four pathways and represent a risk of cardiac arrest.

 

ART Essentials and HealthStream

McElvogue shared that while the ART Essentials program is a stand-alone program focused on the identification of clinical deterioration and the prevention of cardiac arrest, it also works well with other programs for resuscitation education. She went on to share that the program is appropriate for all direct patient care staff across the continuum of care.

McElvogue stressed that HealthStream worked to ensure that the ART program was not a typical online learning experience. The course engages learners with realistic video cases, step-by-step illustrations to ensure comprehension of the physiology of clinical deterioration and knowledge checklists that help ensure that learners can really translate the knowledge and techniques learned into practice. The course includes sections for each of the clinical pathways of deterioration and concludes with a real-life scenario that helps learners put the information into virtual practice.

In addition to the great content, HealthStream is there every step of the way to assist with implementation. HealthStream’s Success Management Team can provide assistance all the way through to implementation and then continues to provide updates on product enhancements and updates. The implementation guide also helps users understand how organizations can take the ART principles and incorporate them into current practices and policies.

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