Sophisticated surveillance technologies have taken patient care to a new level
Clinicians are experiencing data overload, exacerbating the potential to stall decision making, and, thereby, negatively impacting patient care. Experts agree that a shortage of intensivists, cardiologists and nurses in the U.S. will only worsen in the next five to 10 years as the need for their services increases. Advanced wired, wireless and telemedicine monitoring technologies are helping to meet the increasing demands of an aging population and decreasing healthcare resources, while leading to improved outcomes and reduced lengths of stay.
Swedish Medical Center in Seattle, a three-hospital, four-campus operation that generates about $1.3 billion in revenue annually, considers itself a digital leader in the Northwest, according to Rodney Hochman, MD, its CEO. The complex maintains a fully operational EMR, is involved in a telestroke project out of Massachusetts General Hospital and has installed the Visicu (Philips Healthcare) electronic ICU (eICU). Visicu allows intensivists and critical care nurses at the eICU command center to make virtual rounds of patients through an elaborate network of cameras, monitors and two-way communication links via T1 lines. Intensivists can remotely monitor the condition of patients, check vital signs and communicate with hospital staff, patients or family members.
“Remote intensive care monitoring is a big deal for the cardiology community,” Hochman says. “It helps to relieve stress on cardiologists, as well as critical care physicians and nurses, because they do not have to be onsite and they know their patients are receiving the best care.”
Hochman previously held the position of senior vice president and chief medical officer for Sentara Healthcare in Norfolk, Va., when it installed the Visicu program. In its first year of use at Sentara Norfolk General Hospital, a 543-bed tertiary care facility, the eICU reduced intensive care mortality rates by 25 percent and shortened the average length of stay for these patients by 17 percent (Crit Care Med 2004;30:31-38). In addition, researchers found that Sentara Norfolk General was able to significantly reduce costs while upgrading the quality of care. Per patient costs dropped $2,150 based on reduced patient expenses and increased ICU capacity. The program generated roughly $3 million in savings above annualized program costs. Sentara Healthcare has since added three other hospitals to the remote monitoring program.
The backbone of the eICU is the software that establishes base-line readouts for every patient, so that even slight changes in a patient’s vital signs are detected and treated. Dramatic changes in vital signs trigger automatic alerts to intensivists or critical care nurses who then work with on-site hospital staff to immediately respond to the patient’s needs. “The important factors are constant surveillance, providing the patient with immediate physician access and arming the physician with the patient information needed to make the right decisions quickly,” Hochman says.
One of the benefits of the eICU model realized by Hochman is that it helps recruit and retain ICU physicians. “That in and of itself pays for the system,” he says. The cost of Visicu depends on the size of its deployment, but “with everything else we spend money on, we think it’s a relative bargain.”
More remote savings
A study presented at the 2009 annual meeting of the Society of Critical Care Medicine found that remote intensivist care through an eICU program saved Avera Health millions of dollars. Participating in the study were Avera McKennan Hospital and University Health Center in Sioux Falls, S.D., and several rural hospitals in the Avera eICU network.
Data were compared before and 30 months after eICU implementation. Among the findings:
- A 37.5 percent reduction in the number of patients requiring transfer from rural hospitals, saving more than $1.2 million;
- An estimated $8 million savings from reduced length of stay in ICUs;
- ICU and hospital mortality rates that were 65 to 80 percent lower than predicted outcomes;
- An overwhelming majority (90 percent) of rural hospital clinical leaders reported being very satisfied with the eICU;
- An overwhelming consensus (90 percent) among rural hospital leaders that patients and families are comfortable staying in the hospital with the added eICU care; and
- A 100 percent agreement among rural physicians surveyed that the remote