The Military Acuity Model - A Patient Safety Initiative


WINNER: MHS Innovation Award

Effectiveness of the Military Acuity Model (MAM) as a patient early warning system.

The MAM was developed for the Air Force Medical Service (AFMS) to fill a void in acuity measurement. Because of the number of junior staff present in most military treatment facilities and the sheer volume of data points that must be analyzed on each patient, a more dynamic tool was developed to identify changing patient condition. The MAM monitors a series of data points in the inpatient electronic medical record (Essentris) and provides an automated acuity score for each patient. This score can then be used to identify which patients are at risk for unwanted outcomes. The repeatable and objective based acuity score, centered on the patient's condition makes the MAM a measure that can be used by all experience levels and clinical specialties. Intervention lead time will be improved as the MAM has incorporated an early warning system demonstrated to enhance recognition of patient decline up to 24 hours before full complications are obvious. It is hypothesized that the combination of the early warning score (stability measure), selected laboratory measures, medications (complexity measure and resiliency measure), and age, weight, fall risk (vulnerability measure) that make up the MAM will allow military clinicians to design and implement countermeasures to avert or minimize complications. A cognitive load balancing methodology, used in conjunction with the MAM, has the ability to identify and implement those countermeasures.

The MAM was derived from existing validated instruments and has been licensed by the Air Force for commercial use. A patent application has been filed. (Serial number 61/695,821 filed August 31, 2012 and titled "Military Medical Acuity Model.").

Research

The Military Acuity Model (MAM) research is an absolutely groundbreaking endeavor for the Military Health Service (MHS) as we currently do not enjoy a true patient acuity measurement system. We are striving to become a patient focused high performance organization, but in this arena we lack cutting edge tools to rapidly capture trends in patient decline. We have relied far too long on antiquated workload management tools to fill this void and our wounded warriors, patients and families deserve the best clinical decision support tools available. The MAM is truly unique in that it focuses on individual patient acuity, not on the tasks we perform for the patient. The confidence curve and brand loyalty we are seeking from our patients and families can be dramatically, positively impacted with this tool.

A research effort is underway to ascertain whether using the MAM in conjunction with the cognitive load balancing methodology can increase intervention lead time and reduce length of stay and unplanned intensive care unit admissions. A larger 'parent' study has been funded by Telemedicine and Advanced Technology Research Center (TATRC). The validation of the MAM in this research project is a critical step forward to propel our rapid response posture to world class performance levels.

The results of this study will provide data on whether the MAM and cognitive load balancing methodology have a possible role in the larger AFMS and Joint community as a tool to identify patients at risk. If the data support further study, implementation at other inpatient facilities throughout the Department of Defense is possible as all use Essentris (inpatient electronic medical record). This could have far reaching, positive benefits and implications (through commercialization) for Military Health Service influence in our national healthcare system and international care outreach.

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