Star Trek at Bedside
Imagine a hospital room, which recognizes doctors and nurses as they enter. Their name flashes on a flat panel screen for the patient and family to see. At the same time, a second monitor, shows the clinician exactly what they need to know at that moment to care for the patient. Information displayed includes: medication due, patient’s vital signs, and allergies. Does this sound like futuristic technology too good to be true? Well, it is not.
The smart room idea has already been developed and tested at the University of Pittsburgh Medical Center(UPMC). They have been testing this since early October at their Shadyside campus. The idea for the Smart Room came about two years ago when a UPMC nurse wearing latex gloves unknowingly went to place an IV in a patient with a latex allergy, causing an allergic reaction
According to the UPMC , the system uses ultrasound tracking to identify the clinicians that might come to advance the care process for a patient. Each worker is assigned a unique tag—smaller than a pager—that emits ultrasonic sound waves, when the person wearing the tag first enters the Smart Room. The ultrasound detector in the room reads the tag and identifies the caregiver by name and job title, displaying the information on a flat-screen monitor at the foot of the patient’s bed. When a caregiver leaves the room, the information disappears from the screen. In this pilot phase, tags have been assigned to doctors, nurses, nursing assistants, phlebotomists and dietary hosts and hostesses.
The biggest benefit of this innovation is in helping improve patient safety. Patient identification is a key factor in the care process and numerous errors can result from not verifying patient id. Smart rooms can help minimize that. In addition medication errors can be greatly reduced. Less obvious benefits can include, improving workflow and minimizing redundancy. The amount of time wasted in communication between care givers to gather information can also be impacted with this system.
**Picture courtesy UPMC media kit
In my previous article on Critical care or Intensive care(The link betweek efficiency and patient safety), we saw how efficiency can impact patient safety and thereby the outcome. Now let us examine a recent innovation in the area of critical care that has actually accomplished this at the John’s Hopkins Hospital, Baltimore,MD.
Poor and inconsistent communication among providers in the intensive care unit (ICU) can lead to a lack of understanding of daily goals and the failure to deliver needed services that accelerate recovery and discharge.
ICU patients tend to have life-threatening problems and complex care needs that require a combination of many treatments and services in order to achieve timely recovery and discharge.
Lack of communication among providers can lead to a lack of understanding about what needs to occur each day in the ICU.
The net result is that patients remain in the ICU longer than necessary, and are at greater risk of harm, including morbidities and mortality.
The ICU care team (which includes the attending physician and/or fellow, anesthesia and surgery residents, a nurse practitioner, a nurse, and a pharmacist) visits each ICU patient every day between 20 and 25 minutes and uses the ICU Daily Goals Form to document the This creates a standardized way to communicate with one another and a focussed plan of care.
The benefit of this innovation may be greatest with high-intensity patients, such as those in the ICU. It also may be most applicable in academic medical centers and other organizations where ICU care is provided by many different types of practitioners.
Reduced LOS – At Johns Hopkins where this innovation was pioneered, the mean length of stay in the ICU reduced from 2.2 days to 1.1 days
Over a year approximately five million people recieve Intensive care in the United States. In hospitals we refer refer to these patients as ‘critical care’. While the ICU in most hospitals is perhaps the most well run unit from a patient safety standpoint. There is still room for improvement from an efficiency standpoint. And if we increase efficiency we can greatly affect clinical outcomes and paitent safety.
Now wait a minute, how is that possible. Isn’t efficiency about financial dollars for the hospital and something about working like Toyota or GE. What has it got to do with patient care, safety and clinical outcomes ? Ok, let us look at some facts and you can decide for yourself.
Facts from America’s ICUs
The average length of stay in an ICU unit is 4 days
Average number of Critical care/ICU patients per day is 90,000
The average survival rate is 86%
You might say 86% is not bad, and infact its a good outcome in most clinical areas. But consider these facts,
Infections are the main cause for fatality in critical care
4% of all patients contract line infections after 10 days
After 10 days with a catheter 4% of patients (in the US) develop bladder infections
After 10 days on a ventilator 6% develop penumonia and 40-50% of cases result in death
In other words, as length of stay increases (which is an important efficiency metric) the chances of survival reduce greatly. Ok now, let us consider the costs.
On average ICU patients occupy 10% of total beds in the US
On average ICU beds account for 30% of an acute care hospital cost in the US
The total cost of critical care is $180 billion in the US
I hope I have made a case for improvements in the ICU.
(*Stats Ref: Dr. Atul Gawande’s article in the New Yorker and the Society for Critical Care Medicine)