 I always wanted to be a nurse, and my mom used to take me to work with her, and so I would see her running the ER and see her taking care of people. And I have been with Kaiser for 25 years, and I started out as a nursing assistant and went to school, became an RN, and back in April, I took this position with AAM and started working a virtual RN. I was one month into the AAM role and it did become very personal for me. I had my left kidney removed, found out it was cancer, but while I was in the hospital, the day I was supposed to come home, my blood pressure suddenly went down quite low, and before I knew it, there was a team of people at my bedside called a rapid response team. When I walked into the room, it was explained that we received this alert from a nurse, and I'm thinking alert from a nurse, huh, wait, that sounds like my department. And I said, are you the rapid response nurse? And this gentleman said yes, I am. And I said, well, hi, you know, my name's Patty, and I'm new to AAM. And so this is what happens when I call. Turned out fortunately that everything was fine, but I did have the beginning of pneumonia. So I was so grateful to the fact that it was all so fast that they picked up so quickly. I spent an extra night in the hospital, and I felt terrific. I came home. I had no discomfort. Everything was absolutely wonderful. We really want to prevent harm from happening, putting systems and processes in place that prevent failure and predict who is with us and what are the conditions that they're battling with so that we can better support them during their stay in the acute care setting so that we can help them get out of the hospital earlier and get home in a better condition to be successful. Advanced Alert Monitor is one of these systems. I started working on this in 2005-2006 when I observed that patients who deteriorated on the ward and went to the ICU had far worse outcomes than patients who went to the ICU directly. Kaiser Permanente has this incredible opportunity because we have an integrated medical record. So we have access to data from our members from their outpatient experience through any acute care experience and back into the outpatient setting. So with this rich data we thought could we better predict and anticipate our patients' conditions in advance. The data sets are quite large. The current equations, part of them are based on a couple of million patients. The actual alert equations are based on 650,000 patients of whom about 20,000 had a deterioration. So this is the largest such data set in the world. So using patterns of historical data we can now predict 12 hours advance and find out which patients are most likely to up-transfer in the next 12 hours. We could then put together a workflow cascading through virtual support, a highly skilled rapid response ICU nurse and the most responsible physician in succession as well as the supportive care service team reliably to intervene consistently with these patients 24-7. Those early interventions make all the difference in saving the patient from really significant clinical deterioration within 12 hours but we also recognize that you know if we were going to be asking our rapid response team our ends to look at the data on an hourly basis that would be a cause of alert fatigue. Alarm fatigue. Alarm fatigue is something that we focus early on in this program and so having a hub of nurses that are able to look at these alarms that go off on certain patients and actually contextualize the alarm they can look through the chart and and really decide is this a true alert? Is there something that's not being done? Is there a reason to ignore the alert? AAM is a safety net. Ideally the the vigilant attentive doctor and team that has everything go perfect would catch all these patients that's not the reality so this allows us to provide care even when we're not at the bedside. It's giving us a prompt to go investigate, go double check, go get another set of idols and and sometimes we find something and we find something we have the systems in place to act rapidly. It was the most wonderful experience and one that I wish we had when I was in nursing. I believe they saved their life and to know that somebody out there was watching over my mom when there wasn't a nurse at her bedside it was pretty special to me.