With a national shortage in intensivists looming, this Chicago hospital system turned to technology to improve its ICU mortality rates. Resurrection Health Care wasn’t looking for an information system when it launched its mission to build a better ICU. But that’s what it ended up with—and then some. After forming a task force to explore new safety approaches and ways to improve quality of critical care, the eight-hospital system in the Chicago area implemented the eICU program from Visicu, a Philips Healthcare company.

“We said, ‘We want to improve patient care and save lives, what do we need to do?’” said Pat Shehorn, CEO of Westlake Hospital in the Resurrection system and executive sponsor of the project. The task force of physicians, nurses, and administrators came back with bad news: board-certified critical care physicians are expensive and in short supply. “You could do it by hiring tons and tons of people. Or you could use technology,” said Shehorn.

The Visicu solution is essentially an information system on steroids, combining elements of electronic record-keeping, algorithm-based decision support, data analysis, and videoconferencing to reshape workflow and decisionmaking models in the ICU. 

“We’re selling transformation,” said Deb Dominianni, director of corporate communications for Visicu. The company works with hospital systems to create remote centers, called eICUs, that are fed electronic data from each patient’s bedside. At the center, which is staffed and hosted by the hospital system, one specially trained nurse and one intensivist can monitor many patients, supporting the ICU clinical team and often spotting trends that indicate a health crisis before it happens.

When the computer system generates an alert to a potential problem, the remote team can turn on a camera to observe the patient and a speaker to talk with a nurse. Likewise, if a nurse working a late-night shift notices a disturbing change in a patient, s/he can hit a button to call a board-certified intensivist at the eICU for consultation. 

If that patient needs medication, the remote (and already awake) physician can write the order on the spot, saving valuable time. And with the hub-and-spoke remote-care model, many hospitals can share access to those increasingly rare critical care specialists. 

Guardian angel

Resurrection installed its eICU at Holy Family Medical Center in Des Plaines, Ill. and activated its first site at Saint Francis Hospital in Evanston, Ill. in July 2007. It completed installation of all eight hospitals (a total of 182 ICU rooms) in November 2008. In the first six months of use in the first three facilities, it reported a 41% reduction in mortality and a 38% reduction in length of stay. In that time frame, Resurrection estimates it saved 98 lives. 

“The nurses love it, and they feel more secure,” Shehorn said. “One family member referred to it as a guardian angel.” 

Resurrection’s results are fairly typical, said Dominianni. “On an aggregate basis, we’ve seen a 29% reduction in mortality across 185,000 patients in a two-year period, 156 hospitals total.”

Although the remote-staffing model and videoconferencing capabilities are a valuable addition, Resurrection staffers say more common elements found in critical-care information systems, such as clinical documentation and outcome reporting, are also essential to their improvements in patient care.

“The whole standard of documentation has improved,” said Becky Rufo, Resurrection’s eICU operations director and a critical care RN. “It’s forcing hospitals to look at their processes and see how they can be refined. Instead of having 50 million pieces of paper, now it’s in an electronic flow chart.” 

A study by Dr. David H. Wong, et al. reported in the October 2003 issue of Critical Care Medicine concluded that installation of an ICU information system decreased the percentage of time ICU nurses spent on documentation by more than 30% while increasing the time spent on patient care and patient assessment.  

The application used in that study was GE Healthcare’s QS Critical Care Clinical Information System, featuring electronic interfaces between ICU bedside monitors and the hospital’s laboratory information system and patient tracking system. The current generation of QS Critical Care allows for enterprise-wide networking, intranet, and Internet access.

Other solutions on the market include Picis Critical Care Manager, Cerner Critical Care, and Eclipsys Sunrise Critical Care.

Deeper involvement

By integrating the Visicu application with its McKesson Horizon Clinicals information system, Resurrection has brought its entire critical-care multidisciplinary team (nurses, doctors, pharmacists, respiratory therapists, social workers, and dietitians) on board.  

“The organization drove our model of integration,” Rufo said. After activating the first site, additional groups involved in patient care requested access. “We would take what we learned at that site and go to the next site, and they’d see a way to use it differently. It led to deeper and deeper involvement by our healthcare team. And they were hungry for it.” 

Some users had never so much as used a computer mouse, she said, but the intuitive nature of the system, coupled with lots of planning and training, made for a smooth transition at each site.

The system’s interactivity and data-driven outcome reports have generated new interest in critical care all the way up the leadership ladder, Rufo said. “Although the healthcare industry is struggling with lots of challenges, we’re not disengaged here. This is the real deal. It’s heightened everyone’s awareness of clinical excellence.” 

Shehorn said the executive team has been very pleased with its investment in quality of care. “It’s a predictive model. You can look at all the data simultaneously, the bedside team and the remote-site team, and it allows you to look at these early results and take preventive action. It’s a life saver. It’s the future of medicine,” she said. 

Shehorn noted that the hospital plans to take the system beyond critical care into emergency care and said it’s also ideal for rural hospitals. “With remote ICU centers, we could be on the moon, it doesn’t matter.” 

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