Semester

Summer

Date of Graduation

2025

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Not Listed

Committee Chair

Aaron Ostrowski

Committee Member

Allyson Knight

Committee Member

Zachary Volzer

Abstract

Introduction/Background: Adult hospitalized medical and surgical patients at an academic medical center are being transferred out of the Intensive Care Unit (ICU) to the step-down floor and having rapid response calls in less than 48 hours after the transfer. Nurse intuition is not a consideration in the decision to transfer a patient. Physiological variables such as Modified Early Warning Scores (MEWS) and vital signs are relied on heavily as indicators for escalation or de-escalation of care. There is evidence supporting the use of acknowledging nurse intuition to better predict a patient’s readiness for transitions of care.

Purpose: To evaluate the correlation between nurse intuition, MEWS, and patient’s returning to the ICU within 48 hours of initial ICU to step-down unit (SDU) transfer. To assess nurse demographics and perceived usefulness of the NIPDS in practice.

Interventions: Introduction and implementation of the Nurse Intuition Patient Deterioration Scale (NIPDS) on the Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU) and their commonly used parallel (SDUs) of 8 South-East and 7 East. Introduced a nurse demographics / NIPDS perceived usefulness survey to nurses and encouraged participation. Analyzed for completion of NIPDS and calculated if a significant correlation existed between NIPDS scores and patient transfer timelines. Assessed survey results for trends in nurse demographics and perceived usefulness of NIPDS.

Methods: The Plan-Do-Study-Act Model was used to translate the project aims and objectives into current practice at RMH. Education was presented on how to fill out the NIPDS, when to document it, and where the completed forms would be kept. All NIPDS forms were provided on brightly colored paper. Retrospective chart reviews took place to assess patient transition timelines and were recorded in an Excel document. The surveys were in a Likert scale format initially distributed through barcodes made available in emails and placed on common grounds of each floor. The survey was later converted to an in-person format due to lack of participation. Adjustments to the project were made as needed throughout the implementation period. The project received Institutional Review Board approval.

Results: A chi-square analysis was utilized to calculate the relationship between NIPDS scores and patient transfers throughout the MICU, SICU, 8 South-East, and 7 East. Frequency percentages were used to assess survey results. The results for correlation between NIPDS scores and patient transfer timelines were statistically significant. There was not a significant relationship between MEWS and patients going back to the ICU. Most participating nurses answered that they found the NIPDS to be a useful tool in practice.

Conclusions: The statistically significant results along with the background evidence, further supports nurse intuition as helpful in predicting patient trajectory. Most nurses answering that they found the NIPDS to be useful in practice, greatly benefits the sustainability. The project could easily be recreated using the NIPDS tool on paper or integrating it into the Electronic Health Record (EHR). There is also possibility for expansion of this project throughout other ICUs and SDUs.

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