Implementation of a Clinical Deterioration Tool Improves Outcomes

Monday, March 23, 2026

11:30 AM - 12:30 PM Central Time

Location: Connections Central - RST 17

Jennifer Johnson, APRN

Yale New Haven Health, Connecticut

Disclosure(s): No relevant financial relationship(s) to disclose.
CN

Christine Needham, APRN

RRT Manager
Bridgeport Hospital

Disclosure information not submitted.
DL

Deirdre Lamoureux, RN

Medicine Clinical Nurse Educator
Yale New Haven Hospital

Disclosure information not submitted.
AA

Anne Aquila, RN

Nursing Director
Bridgeport Hospital

Disclosure information not submitted.
SS

Shivi Sharma, MD

Hospitalist Director
Yale New Haven Hospital

Disclosure information not submitted.
JM

Jared Moreines, MD

Hospitalist
Yale New Haven Hospital

Disclosure information not submitted.
JM

Jensa Morris, MD

Smilow Hospitalist Director
Yale New Haven Hospital

Disclosure information not submitted.
CM

Catherine Maslan, RN

Surgical Nursing Educator
Yale New Haven Hospital

Disclosure information not submitted.
PS

Prasama Sangkachand, MSN, CCRN

HVC Nurse Educator
Yale New Haven Hospital

Disclosure information not submitted.
AL

Amanda Luyckx, RN

Nurse Educator
Yale New Haven Hospital

Disclosure information not submitted.
JL

Jessica Luyckx, RN

Nurse Educator
Yale New Haven Hospital

Disclosure information not submitted.
GM

Geraldine McSherry, RN

RRT Nurse Manager
Yale New Haven Hospital

Disclosure information not submitted.
LA

Lirim Ameti, MD

Hospitalist Director
Yale New Haven Hospital

Disclosure information not submitted.
TM

Thea Malile, RN

Nurse Educator
Yale New Haven Hospital

Disclosure information not submitted.
DE

Dana Edelson, MD

eCART Founder
University of Chicago Medical Center

Disclosure information not submitted.
JR

Joe Reid, RN

eCART Lead
University of Chicago

Disclosure information not submitted.
LD

Laura DeVaux, RN

Resuscitation Team Lead
Yale New Haven Hospital

Disclosure information not submitted.
MM

Melissa McKay, RN

Resuscitation Team
Yale New Haven Hospital

Disclosure information not submitted.
LA

Larry Akrong, RN

RRT RN Assistant Manager
Yale New Haven Hospital

Disclosure information not submitted.
JS

Jonathan Siner, MD

Associate Chief Patient Safety Officer
Yale School of Medicine

Disclosure information not submitted.

Introduction: In January 2024, our health system implemented eCART (AgileMD) to better identify patients at risk for clinical deterioration. eCART is an FDA cleared, early warning score that uses a machine learning model incorporating 97 variables (including vital signs, labs, and nursing assessment) to generate risk prediction of ICU transfer or death within 24 hours. eCART is paired with “Care Signature” pathways to standardize nursing and provider response to patients at risk of clinical deterioration, encourage activation of the rapid response team (RRT) when appropriate, and closely monitor at risk patients. eCART provides process metrics to track hospital and unit level compliance. The clinical team meets regularly to discuss cases and monitor process metrics including time to first view of the elevated score and pathway completion. Since go live, we have universal adoption of eCART with sustained process metrics above goal.

Methods: A retrospective review of consecutive patients with a RRT activation across seven hospitals between January 1, 2021 and June 30, 2025 was conducted. We sought to determine if eCART implementation improved outcome metrics, specifically mortality, hospital length of stay (HLOS), and RRT activation. HLOS was calculated based off a $1000 per day cost avoidance.

Results: Post eCART implementation, improvements are demonstrated in all outcome metrics. Mean number of RRT activations per quarter increased by 437 (95% CI 269.6 to 603.9, p< 0.0001). HLOS for RRT patients decreased 3.3 days (95% CI -0.4 to -6.6, p=0.028). Patients with a RRT demonstrated improved survival to hospital discharge (OR, 0.84; 95% CI, 0.74 to 0.95, p=0.004). Reassuringly, median duration of RRT activation only increased from 39 minutes pre-intervention to 43 minutes post-intervention. The reduction in HLOS translates to an annual cost avoidance of $5,000,000.

Conclusions: Implementation of eCART, clear nurse and provider workflows, and data to track process metrics is leading to improvement in outcome metrics. Outcomes since eCART implementation show statistically significant improvement in mortality, HLOS, RRT activation, and a large cost avoidance.