NEHI’s third report in a three-part series about the state of tele-ICU care focuses on the best practices that are needed to effectively utilize tele-ICU to meet the critical care crisis in California. The report, titled Emerging Practice Patterns in Tele-ICU Care, was supported by the California Healthcare Foundation and other funders and was recently released on CHCF’s website. You can find the full NEHI report at http://www.chcf.org/publications/2014/01/teleicu-care.
Peformance ICU Blog
This article in Modern Healthcare brings up a lot of important issues around the need for technology interoperability.
One of the things I have been working on in a large western state is supporting the groups that are establishing the technical standards for Health Information Exchange (HIE). Their approach is to use HL7 software standards to connect disparate technology platforms instead of the unsuccessful approach of trying to convince hardware and software vendors to agree to a complete set of interface standards.
That is why Performance ICU’s integration vendor, CPC, (a middleware integrator) is in such demand these days. They and companies like them are leveraging HL7 standards to successfully allow patient room related vendors and technology manufacturers to securely transmit data to one another both locally and remotely
The author of the article calls middleware integration problematic. The alternative being suggested (of plug and play technology standards) has already been considered and ignored by most of the national health care standards committees.
Performance ICU’s combined clinical and technology solution bypasses the deep chasm of non-interoperability by intentionally using middleware integration and connecting the existing configuration of vendors and technologies our hospital customers may have in place to provide secure Tele-ICU services
Most importantly, however, the Performance ICU team of intensivists adds the highest level of connectivity in an ICU setting. They are able to continuously monitor patient information from all the medical devices, patient medical records, clinical care team, and seeing and speaking with the patients via technology for themselves. They connect all the dots and ensure proactive response to all the information. They make the highest and best use of information and resources for excellence in caring for the most vulnerable patients. Timely response to real time information is the goal beyond interoperability.
Read the full Modern Healthcare article here.
Comments by Daniel Glaze, CPHIMS, PMP, Glaze & Associates LLC
Expanding telemedicine coverage through Medicare and Medicaid is the aim of a bill introduced by a bipartisan group of House lawmakers last week.
The Telehealth Enhancement Act of 2013 builds on existing payment innovations. The legislation aims to address physician shortages and concerns with patients’ access to quality and affordable health care. Among other reforms, the bill adjusts Medicare home health payments to account for remote patient monitoring and expands coverage to all critical access and sole community hospitals. The legislation also covers home-based video services for hospice care, home dialysis and homebound beneficiaries.
Performance ICU, along with many other organizations, including the American Telemedicine Association, supports the new bill.
“Telehealth technology has a tremendous impact on improving access, reducing costs and improving quality of care,” says Anne Connolly, Performance ICU chief administrative officer. “It brings high quality health care to the patient, wherever that patient is located. Boosting telehealth coverage is critical to the future of health care.”
The bill has been referred on to the House committees and Energy and Commerce and Ways and Means.
The Sacramento Area Regional Technology Alliance spotlighted Performance ICU at its MedStart mixer on Sept. 25. The event showcased the exciting progress the Sacramento region’s medical technology community is making.
Attendees heard personal stories from Performance ICU and three other startup med and biotech companies about their innovations, start-up challenges and milestones achieved. In addition to Performance ICU, featured companies were:
- The Locking Cap – combination locks for prescription medications
- Optimal Tracers – customized radiotracers for diagnostic and therapeutic development
- Tahoe Institute for Rural Health Research – an automatic blood pathology system
The networking event also highlighted BGI, the world’s largest genomic institute, as SARTA’s 2013 “Succeeding in Sacramento” med tech organization.
“The Sacramento region is making a name for itself as a leader in medical technology innovation and development,” says Muhammad Afzal, M.D., Performance ICU CEO. “Performance ICU is thrilled to be recognized by SARTA for its work to deliver Tele-ICU care to improve clinical quality and reduce costs to hospitals across the country.”
The use of mobile carts and robots in hospitals is becoming increasingly common and can be an effective part of a comprehensive Tele-ICU program. Robots and carts are equipped with interactive audio and video, as well as various devices, including stethoscopes and ultrasounds, which connect remote physicians to the bedside.
At Performance ICU, we believe mobile carts and robots can be an appropriate audiovisual solution for a Tele-ICU program in certain circumstances. Cart and robot technology can support bedside clinicians’ episodic needs for telehealth consults when a second opinion or higher level of expertise is needed.
While robots and carts can be effectively incorporated into patient care, Performance ICU believes they are not a substitute for a comprehensive Tele-ICU program, which provides proactive, continuous monitoring to help hospitals achieve clinical and financial improvements, including shorter lengths of stays, lower complications and reduced nursing staff turnover.
“Our Tele-ICU program is about comprehensive management of critical care patients with integration of best technologies, evidence-based best practices and collaboration of on-site and off-site clinicians,” says Muhammad Afzal, M.D., Performance ICU CEO. “It is about leveraging everything available, including carts and robots where needed, to improve patient outcomes, increase access to care and achieve financial improvements.”
Telemedicine is enabling neonatologists in Denver to beam in to 33 rural hospitals in three states to help critically ill infants. Similar to tele-ICU programs, the Rocky Mountain Hospital for Children’s neonatal telemedicine program provides real-time access to specialists, who can assess a patient and help administer care, as well as provide a second opinion. The program has greatly reduced the number of premature and ill infants requiring transfer to a larger medical center.
Read about Rocky Mountain’s neonatal telemedicine program here.
NEHI recently released its third report in a three-part series prepared for the California Health Care Foundation about the state of tele-ICU care in California. The report, Emerging Practice Patterns in Tele-ICU Care, focuses on the best practices that are needed to effectively utilize tele-ICU to meet the critical care crisis in California.
California’s high ICU mortality rate of 20.6 percent and shortage of intensivists are two of the state’s biggest and most urgent critical care challenges. Additionally, fewer than 10 percent of California’s hospitals meet the Leapfrog Group’s 24/7 intensivist staffing recommendation. The NEHI report, released in June, highlights these challenges, as well as California’s limited dissemination of tele-ICUs, where fewer than 7 percent of the state’s adult critical care beds have tele-ICU coverage, compared to 13 percent nationwide.
The report suggests that tele-ICU is poised for major change in California and around the country, highlighting several innovative tele-ICU practice patterns across the U.S. that make coverage more scalable, flexible and affordable. “Performance ICU is pleased to be identified in the report as a proven group of tele-ICU physicians offering new lower cost and vendor-neutral options for implementing tele-ICU coverage,” says Muhammad Afzal, M.D., Performance ICU CEO.
To read more about emerging tele-ICU best practices and applications for California’s hospitals, find the full NEHI report here.
ICU Admissions at U.S. hospitals increased by 50 percent from 2002 to 2009, while emergency department admissions increased by only 5.8 percent, according to a study in Academic Emergency Medicine.
Lead author Peter Mullins of George Washington University’s School of Public Health and Health Services found that ICU admissions rose from 2.79 million in 2002 – 2003 to 4.14 million in 2008-2009. The most common reasons for ICU admissions were symptoms like chest pain and shortness of breath, which can signal life-threatening conditions like heart attacks.
Researchers say the reason for the major increase in ICU admissions remains unclear. However, Mullins said in a statement that the increase may be the result of an older, sicker population that needs more care.
The study raises the question of whether there will be enough ICU capacity in the future to accommodate the increased demand from the nation’s rapidly aging population. The Journal of the American Medical Association estimates that by 2020, the U.S. will be 22 percent short of the number of critical care physicians needed.
As hospitals seek solutions to help care for the influx of aging patients and deal with the worsening intensivist shortage, tele-ICUs will play an increasingly important role in the care and management of ICU patients.
“We believe the timing is right for Performance ICU’s services,” said Muhammad Afzal, M.D., Performance ICU CEO. “Hospitals are aggressively looking for solutions that improve patient care and deal with the shortage of intensivists and increasing number of elderly patients. Tele-ICU medicine has been proven to do just that.”
Performance ICU congratulates its colleagues at Sutter Amador Hospital, Sutter Auburn Faith Hospital, Sutter Davis Hospital, Sutter Medical Center, Sacramento, Sutter Roseville Medical Center and Sutter Solano Medical Center. These six hospitals were honored with Hospital Safety Scores of “A” by the Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits.
The A scores were awarded in the latest update to the Hospital Safety Score, the A, B, C, D or F scores assigned to U.S. hospitals based on preventable medical errors, injuries, accidents and infections. The Hospital Safety Score was compiled under the guidance of the nation’s leading experts on patient safety and is designed to give the public information they can use to protect themselves and their families.
According the Leapfrog Group, the majority of U.S. hospitals have made only incremental progress in keeping patients safe from medication errors, accidents, injuries and hospital-acquired infections. Of the 2,514 hospitals that were assigned safety scores, 1.9 percent showed dramatic change in their Hospital Safety Score, moving two or more grade levels up or down, while 73.9 percent of hospitals maintained the same score from November 2012. Of the general hospitals scored, 780 earned an “A,” 638 earned a “B,” 932 earned a “C,” 148 earned a “D,” and 16 earned an “F.”
We commend these Sutter hospitals for their focus on safety, which includes following ICU best practices and protocols for glycemic control, sepsis, and central line-associated bloodstream infections. As critical care physicians and a provider of tele-ICU services, we know initiatives such as these truly make a positive impact in reducing ICU complications and improving patient safety.
Performance ICU had the privilege to attend the Sacramento Regional Technology Alliance’s fourth annual Med Tech Showcase this week. The event spotlighted the growth in bioscience and med tech in the region and highlighted opportunities for med tech in the changing health care delivery marketplace. Performance ICU was pleased to be recognized by SARTA as one of 18 new med tech companies in the Sacramento region to open its doors.
A panel discussion on the future of med tech, comprised of representatives from several local health care organizations, provided a fascinating glimpse 10 years into the future. Panelists predict that robotics will replace lower level patient care providers, regenerative medicine will reduce the need for pharmaceuticals to manage health conditions, and vast amounts of data will allow people to direct their own care.
Philips Healthcare Senior Vice President and Chief Medical Officer Eric Silfen, M.D., concluded the Med Tech Showcase with an inspiring keynote address about innovation in the medical device industry.
It was a pleasure to attend the event and hear about the many exciting developments in the Sacramento region medical device and medical technology industry. Performance ICU is thrilled to be among those companies dedicated to bringing innovative and meaningful solutions to our health care system.
A report published in the April 3 issue of the Journal of the American Medical Association found that mortality is highest among Medicare patients at critical access hospitals. The study looked at Medicare data on 30-day mortality rates for three major conditions at critical access hospitals, which showed an average annual 0.1 percent increase during the nine-year study period versus an annual decrease averaging 0.2 percent in other hospitals.
Although the findings did not cover potential contributors to health problems, such as patients’ smoking habits and body mass index, the findings suggest that critical access hospitals have not kept pace with other hospitals because of the changing nature of hospital care and limited access to rapidly changing technology.
At Performance ICU, we believe that tele-ICU and other telemedicine initiatives play a valuable role in filling the gaps for critical access hospitals by bringing intensivists and other specialists to the bedside for advice and management.
Read the full Reuters story here.
Performance ICU just returned from the California Telehealth Resource Center’s inaugural 2013 Telehealth Conference in Napa, Calif. The conference was well-attended, drawing nearly 300 attendees from across the state.
The event highlighted the best and promising applications and practices from telehealth leaders; how telehealth fits into today’s health reform ideas; affordable technology innovations that won’t break the budget; and telehealth integration into Health Information Exchange challenges and successes.
“With the Affordable Care Act, hospitals will see increased demand for services from the newly insured, resulting in much more expensive care for those with chronic diseases that are not controlled. The risk of instability may lead to increased hospital admissions, pointing to a greater need for intensivists,” says Anne Connolly, Performance ICU chief administrative officer.
Performance ICU enjoyed the opportunity to exchange ideas about telehealth and its role in health care reform and meet others in the telemedicine industry.
Mortality as a measuring stick for hospital performance is the subject of a column in the February 2013 issue of The Hospitalist. Columnist Win Whitcomb, M.D., MHM, writes about how hospitalists can play an important role in reducing hospitals’ 30-day mortality rates and avoiding potential cuts to Medicare reimbursement.
Dr. Whitcomb believes hospitalists should target four key areas for mortality reduction: reducing harm; improving teamwork; improving evidence-based care; and improving transitions of care.
Intensivists can support the hospitalist by assisting in the evaluation and management of critically ill patients, who often need a higher level of expertise, or procedures or interventions that hospitalists aren’t trained to provide. In addition to caring for patients, intensivists work in close collaboration with hospitalists and other members of the health care team to create and implement evidence-based protocols that optimize care and reduce mortality.
Whether they are based in the hospital or remotely, intensivists, along with hospitalists, play an important role in reducing hospitals’ mortality rates.
Read the full column here.
The American Association of Critical-Care Nurses has issued its first-ever practice guidelines specifically for the growing subspecialty of Tele-ICU nursing practice.
The aim of the new practice guidelines is to bring consistency across new and existing Tele-ICUs, serving as a benchmark for the growing number of registered nurses who practice within the Tele-ICU model of care.
One of Performance ICU’s strengths is the consistent implementation of evidence-based best practices for all medical disciplines, and we commend the AACN’s Tele-ICU Task Force for its work in establishing these guidelines. ”We look to our professional associations to support the creation of standards and tools that will benefit nurses and other clinicians, including those who work from a remote monitoring location,” commented Performance ICU Chief Operating Officer Jude Sell-Gutowski, RN, MS.
The AACN Tele-ICU Nursing Practice Guidelines are available for download from the AACN’s website.
Performance ICU was pleased to take part in the California Hospital Association’s RuralHealth Care Symposium as a sponsor and participant. The three-day conference, themed “Transition to a Brave New World,” took place in Sacramento and drew rural health providers from around the state.
Rural hospitals face a host of significant pressures – largely beyond their control. Their challenges include recruiting and retaining workforce, declining government payments, older and sicker patient populations, aging facilities and equipment, and access to technology that can enhance quality initiatives.
“It is clear that value rather than volume will be the key for health care reimbursement in the future,” says Anne Connolly, Performance ICU chief administrative officer. “We believe that tele-ICU can support rural hospitals in delivering high quality care through continuous monitoring by board certified intensivists, mentoring and support for bedside care teams and best practices standardization.”
CHA’s Rural Health Symposium was a wonderful opportunity to hear many informative presentations and personally talk with leaders from the rural health care arena to learn more about their unique circumstances.
This week is National Patient Safety Awareness Week, and several organizations, including the National Patient Safety Foundation (NPSF) and the American Society for Healthcare Risk Management *(ASHRM), are asking hospitals and patients to recognize the advancements that have been made in the patient safety arena, while acknowledging the challenges that remain – and committing to work on them every day.
The ASHRM aims to assist hospitals in adopting practices that have the potential to reduce inpatient harm by 40 percent and readmission by 20 percent. The organization offers strategies, tips and resources to help hospitals improve patient safety in the following areas:
- Adverse Drug Events
- Catheter-Associated Urinary Tract Infections (CAUTI)
- Central Line-Associated Blood Stream Infections (CLABSI)
- Injuries from falls and immobility
- Obstetrical adverse events
- Pressure Ulcers
- Surgical Site Infections
- Venous thromboembolism (VTE)
- Ventilator-acquired pneumonia (VAP)
Tele-ICU is a proven and powerful tool to help hospitals save lives and lower costs through the implementation of best practices, mentoring and support for bedside nursing staff, and immediate access to intensivists. Tele-ICU can support the implementation of the ABCDE bundle (Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility), shown to reduce the incidence of venous thromboembolism and pressure ulcers. Performance ICU intensivists have also successfully implemented bundles to achieve significant and sustained reductions in CLABSI and VAP rates. In addition to implementing evidence-based best practices, Tele-ICU intensivists and nurses provide immediate mentoring and consultation to direct care nurses to reduce the incidence of adverse drug events.
We know patient safety is a top priority every day. Performance ICU applauds hospitals for their ongoing commitment to adopting practices that help eliminate or minimize serious safety events.
Congratulations to our colleagues and friends at Sutter Medical Center, Sacramento and Sutter Davis Hospital for being named as two of the 100 Top Hospitals® in the nation by Truven Health Analytics.
The 100 Top Hospitals® study uses research and independent public data to recognize the best U.S. hospitals. The study looks at many measures of hospital performance, from patient satisfaction and patient safety, to medical complications and readmission rates. This is the third time Sutter Medical Center, Sacramento has made the list and the fourth time Sutter Davis has earned the recognition.
Kudos to both hospitals for their continuous commitment to providing high quality patient care!
Read The Sacramento Business Journal’s story about the recognition here.
By Jude Sell-Gutowski, RN, MS
Performance ICU Chief Operating Officer
The Association of California Nurse Leaders conference last month, themed “Courage to Lead: Igniting Our Passion,” brought together hundreds of nurse leaders from around the state for a productive and inspirational four-day event. Though I no longer provide direct patient care in my current role as chief operating officer at Performance ICU, the nurses’ energy and commitment to patient care and safety reminded me why I went into the profession and why I love what I do. It was truly a memorable conference.
For Performance ICU, the conference started at the President’s Brunch, where Dr. Muhammad Afzal gave a talk about the work Performance is doing in collaboration with its hospital partners to optimize care through Tele-ICU medicine. The President’s Brunch is an annual tradition that brings together ACNL past presidents, current and past board members, and honored guests. The impressive group of leaders engaged Dr. Afzal in lively discussion about how Tele-ICU can support nurses in providing quality patient care.
I also had the opportunity to attend many inspiring general sessions throughout the ACNL conference. A session entitled “Profiles in Courage: Nurse Leaders Make a Difference,” featured leadership advice and inspirational messages from three well-known nurse leaders, Marilyn Chow, DNSc, RN, FAAN, Kaiser Permanente National Patient Care Services vice president; Linda Burnes Bolton, DrPH, RN, FAAN, Cedars-Sinai Medical Center vice president and chief nursing officer; and David Vlahov, PhD, RN, FAAN, UC San Francisco School of Nursing dean and professor. The trio shared insights about their career paths, reminded the group that nursing is the business of caring, and encouraged us to practice leadership every day.
One of our beliefs at Performance ICU is that our monitoring technology is simply a tool to help deliver proactive, timely patient care. Jim D’Alfonso, MSN, RN, NEA-BC, Kaiser Permanente Northern California regional operations director, so eloquently reaffirmed this belief during his presentation at the conference, stating, “Technology must support our caring, not drive our care.”
We couldn’t have said it any better!
Performance ICU was thrilled to attend SARTA’s Feb.12 MedStart meeting. As an invited speaker, Performance ICU CEO Muhammad Afzal, M.D., highlighted the unmet needs represented by the current low adoption of Tele-ICU. Attendees also heard presenters from UC Davis, Kaiser, CareInnovations, California Telehealth Network, and several for-profit companies.
SARTA is the leading non-profit organization fueling the growth of technology companies in the Sacramento region. SARTA’s MedStart Initiative aims to make health care safer, more effective, and less costly through technology.
Sacramento has a history of successful economic development by committed local business people working together. SARTA’s impressive health care and technology participants appear to be continuing the tradition. Performance ICU is building a dynamic, forward-thinking business model in the regional intersection of health and technology.
Research findings presented at the Society of Critical Care Medicine 42nd Annual Critical Care Congress in January show that patients treated with the ABCDE bundle experience more days breathing without assistance and less delirium.
Though not yet in widespread use, the ABCDE bundle appears to be an effective way to manage sick, mechanically ventilated patients. The study authors noted that communication is one of the biggest challenges to implementation of the ABCDE bundle because the approach requires a coordinated multidisciplinary team approach to care.
Performance ICU recently returned from the Society of Critical Care Medicine conference in San Juan, Puerto Rico, Jan. 19 – 23. Muhammad Afzal, M.D., Performance ICU CEO, and his colleagues heard from several world-renown critical care experts, participated in interactive workshops and educational sessions, and listened to some thought-provoking panel discussions. Tele-ICU was a significant focus of the conference with three excellent seminars that made clinical, quality and financial cases for Tele-ICU.
One of the most valuable aspects of the annual congress was the opportunity to network and mingle with critical care colleagues from across the country. Dr. Afzal (pictured far left) talked with representatives from Bernoulli, as well as a founder of Visicu. Bernoulli and Phillips Visicu both provide Tele-ICU technology platforms that bring critical care experts like Dr. Afzal to the patient’s bedside via continuous real-time patient monitoring and two-way audio and visual communication. Performance ICU utilizes this technology to help hospitals transform care in their ICUs – saving lives, reducing ICU length of stay, and saving money.
Researchers presented new findings related to early fluid resuscitation in sepsis patients at the Society of Critical Care Medicine 42nd Critical Care Congress, Jan. 19-23. The study revealed that early aggressive fluid resuscitation – within three hours – reduces sepsis mortality, illustrating that every hour of hypoperfusion counts.
The Federal Communications Commission on voted on Wednesday to revise and make permanent its universal service support pilot program for health care, according to the American Hospital Association’s NewsNow, a daily report for health care executives.
The new Health Care Connect program will provide up to $400 million annually to support broadband access across the country, particularly for rural health care providers. In changes supported by the AHA, the program will encourage state and regional networks that include both rural and urban participants.
“We are excited to see many of the key components of the pilot program made permanent, and hope that the new program helps bring reliable and affordable broadband to all areas and fosters the development of expansive telehealth networks across the country,” said Chantal Worzala, AHA director of policy, in a statement published in NewsNow.
“Performance ICU is pleased with the FCC’s decision and the strong policy leadership of the AHA regarding the important role of telehealth and the infrastructure to support it,” said Muhammad Afzal, M.D., CEO of Performance ICU. “This ongoing funding will allow the California Telehealth Network, whose mission is to improve access to high quality health care through advanced information technologies, to expand to more sites and continue to provide to their members here in California.”
In light of the worsening nationwide shortage of critical care physicians, The Hospitalist published a front-page story highlighting the provider shortage and possible solutions in its October 2012 issue.
The in-depth story examines how and whether hospitalists might help solve the critical care physician shortage. The article highlights a June 2012 joint position paper from the Society of Hospital Medicine and the Society of Critical Care Medicine proposing an expedited one-year critical care fellowship for hospitalists with at least three years of experience in lieu of the two-year fellowship now required for board certification.
In a sharp response to the paper in July 2012, the American College of Chest Physicians and the American Association of Critical Care Nurses declared that one-year of fellowship training is inadequate to achieve competence in critical care medicine. Featuring interviews with several hospitalist and critical care experts, the story looks at experience versus training, a tiered ICU care solution, and other alternative strategies to solve the critical care physician shortage.
What most everyone can agree on is that health care leaders need to collectively find a solution to caring for our sickest patients. Performance ICU believes that Tele-ICU is an effective strategy for bridging the intensivist shortage gap and delivering high quality, efficient patient care.
Read the full story on The Critical Care Debate here.
-Muhammad Afzal, M.D.
Performance ICU CEO and intensivist
Performance ICU recently attended the California State Rural Health Association’s annual conference in Anaheim. The conference brought together a multidisciplinary group of professionals representing the state’s rural health care safety net. Performance ICU had an opportunity to meet many rural health providers and learn about the challenges they face in delivering care, as well as the successes they have achieved.
Most of these rural health care providers are incredibly stretched. Some rural hospitals are so small their average daily census is four and they typically see only eight patients in their Emergency Department in a 24-hour period.
Many rural health providers we met were not aware that ICU services could be provided virtually, easing the burden for many hospitals impacted by the nationwide shortage of critical care physicians. Additionally, staffing a rural ICU with enough critical care physicians for continuous coverage becomes prohibitively expensive. Consequently, patients at many rural hospitals do not receive the same quality of critical care as those at larger medical centers in urban areas.
Performance ICU sees an immense opportunity to bring experienced critical care physician coverage to rural hospitals via Tele-ICU, enhancing the level of care and allowing patients to remain in their community for care.
Sepsis and septic shock – degrees of the same serious medical condition caused by an overwhelming immune response to infection – is on the rise in U.S. hospitals. Sepsis is a major challenge in the intensive care unit, where it’s one of the leading causes of death. It typically arises unpredictably and can progress rapidly.
Every year, severe sepsis strikes about 750,000 Americans, with at least 210,000 fatalities. As medicine becomes more aggressive, with invasive procedures and immunosuppression, the incidence of sepsis is likely to increase even more.
Why is sepsis becoming more common?
Sepsis is becoming more common, especially in hospitals, as a result of:
- Medical and technological advances associated with diagnosis and treatments
- The increasing number of elderly and/or debilitated people, and patients with chronic and underlying diseases, such as cancer, who require immunosuppressive therapy
- The widespread and sometimes inappropriate use of antibiotics, which encourages the growth of drug-resistant microorganisms
What is being done to combat sepsis?
Earlier diagnosis and treatment has a significant positive effect on survival rates, so many efforts are aimed at finding ways to recognize the onset of the condition more quickly. Once sepsis is diagnosed, rapidly applying evidence-based interventions in a systematic manner and adhering to standardized guidelines can help reduce sepsis mortality and achieve better results for patients.
Tele-ICU programs provide an extra layer of care, helping the hospital care team identify and treat sepsis earlier and more quickly. Continually monitoring ICU patients from a remote monitoring hub, Performance ICU’s expert tele-intensivists use trended data and predictive algorithms as well as automated steps for sepsis screening to proactively identify and improve evidence-based treatment compliance for combating this life-threatening condition.
Intensivist management of ICU patients dramatically reduces mortality and complications for patients and improves financial outcomes for hospitals. It also enhances compliance with established guidelines for ICU care. According to the Leapfrog Group, if all hospitals that do not currently meet the Leapfrog intensive care unit physician staffing standard fully implemented the standard, nearly 55,000 lives and $4.3 billion could be saved in the U.S. health care system.
In addition to caring for patients, board certified intensivists help ICUs create and implement evidence-based protocols that cover a wide range of clinical issues, such as sepsis, glycemic control and pneumonia. Intensivists work in close collaboration with physicians, nurses and other members of the hospital staff to establish those guidelines. They also work closely with hospital clinicians to establish key measures of performance, such as days on mechanical ventilation and length of stay, and set targets for reaching those goals.
The nationwide shortage of critical care physicians makes it difficult for many hospitals to meet intensivist staffing recommendations. To get around this challenge, more and more hospitals are turning to telemedicine to remotely staff their ICUs with intensivists. These Tele-intensivists look after patients continuously from a remote monitoring center, analyzing patient information, making clinical assessments and communicating with patients and hospital-based physicians and nurses.
Whether they are based in the hospital or remotely, intensivists are key players in the ICU to quickly identify and treat problems, preventing complications, reducing length of stay and helping achieve ICU cost savings.
Lower mortality, fewer complications, and shorter lengths of stay. The benefits of using intensivists are clear.
According to the Leapfrog Group – a national initiative focused on hospital safety – intensivists reduce the risk of patients dying in the ICU by 40 percent. According to the Society of Critical Care Medicine, using an intensivist-led multidisciplinary team can reduce ICU length of stay by 30 percent.
So, WHY do intensivists reduce mortality and length of stay?
Catching Problems Early
Where intensivists manage and monitor ICU care, patients’ problems are identified sooner, leading to more rapid and evidence-based interventions and lower mortality rates. Tele-intensivists remotely monitor patients’ vital signs continually and are able to visualize and communicate with patients via a camera. They are able to detect incremental changes in a patient’s condition with views, alarms and alerts that result in proactive prevention or early intervention in the event of a serious medical problem.
Establishing Best Practices
Intensivists work closely with members of the ICU team to implement evidence-based best practices for sepsis, ventilator-associated pneumonia, glucose management and many other quality improvement initiatives. Establishing evidence-based standardized approaches to care reduces the risk of complications that increase length of stay.
Whether they’re at the bedside or in a remote monitoring center, intensivists are a vital component in delivering high quality care to our sickest patients.
Performance ICU has been busy preparing for the official launch of the company this week. Be sure to read reporter Kathy Robertson’s story on Performance ICU’s Tele-ICU services in The Sacramento Business Journal on Friday, Sept. 28. The story will highlight Performance ICU’s business, the need for Tele-ICU and benefits of this higher level of care. Several key players in the health care and Tele-ICU arena were interviewed for the story, including Performance ICU physicians and local hospital executives. The reporter brings a unique perspective to the story as she covered the opening of Sutter Health’s eICU – the first one on the West Coast – nearly a decade ago.
Congratulations to Sutter Medical Center, Sacramento for being one of 244 hospitals nationwide to be named top performer on key quality measures by The Joint Commission, the leading accrediting agency for health care organizations and programs in the U.S. Sutter Medical Center, Sacramento was recognized for top performance in using clinical guidelines shown to improve care for heart attack, heart failure and pneumonia.
As bedside and Tele-ICU physicians for Sutter, Pulmonary Medicine Associates and Performance ICU are proud to support the organization in its ongoing commitment to quality patient outcomes. Read The Sacramento Business Journal’s Sept. 19 story on Sutter’s recognition here.
Reuters Health Information reported in August on a study conducted in 45 ICUs in 35 community hospitals related to CLASBI (central line-associated blood stream infection).
The study found that an 81 percent reduction in CLASBI rates was achieved in 19 months following the implementation of a nurse-driven protocol. While similar results had been reported in previous studies, this is the first study using a phased design that allows for a randomized control period and establishes a causal relationship.
The protocol implemented in the study includes five evidence-based prevention measures along with the implementation of the validated Comprehensive Unit-based Safety Program that includes training and the promotion of a “culture of safety” in the hospital unit.
When asked about this study and its relevance to the community, Performance ICU physician Imran Aurangzeb, M.D., offered the following comment:
Central Line Associated Blood Stream Infections or CLASBI (pronounced class-bee) is a medical complication that may cause suffering and unnecessary death in hospitals. A CLASBI occurs when a venous catheter (a piece of pliable tubing inserted in a large vein to deliver medications) causes bacteria to grow. These bacteria subsequently enter the blood stream and cause a life-threatening infection.
Alan Cubre, M.D., Performance ICU physician, and Co-Medical Director of the ICU and Chair of the Critical Care Committee at Sutter Roseville Medical Center, partnered with nursing staff to implement a CLASBI prevention “bundle.” The bundle includes handwashing prior to performing procedures, donning of gowns, gloves, masks and hairnets, covering the patient with a sterile drape, using a special chemical (chlorhexidine) to kill bacteria on the skin and timely removal of all unnecessary catheters. This partnership resulted in significant and sustained reduction – near elimination – of CLASBI at the hospital.
Nearly 250,000 health care-associated infections occur every year in patients with central lines and roughly a quarter of them die. This adds up to nearly 31,000 deaths annually in the United States and CLASBI has been estimated to cost $9 billion every year to the U.S. health care system.
The study, conducted in two Adventist health care systems, was reported in Critical Care Medicine in August 2012.