$50 million investment to improve patient safety
A California not-for-profit hospital is spending $50 million on new, advanced technology that promises fundamental changes in hospital ICU care and bedside medication delivery, all intended to improve patient safety. The huge outlay of funds is justified by the ability to reduce medication errors and other adverse events, say hospital leaders.
Sutter Health in Sacramento, CA, is implementing two high-tech solutions that promise to improve patient safety — an intensive care unit that allows specialists to view and treat patients remotely and a bar coding system for medications. The hospital is among the first to use technology from Baltimore-based VISICU Inc. to provide physician specialists with tools that will enable them to keep a close eye on critical care patients 24 hours a day, seven days a week. The solution uses telemedicine technology — early-warning software with advanced video and electronic monitoring — to connect off-site critical care specialists to ICU patients. The hospital studied the project for a year before deciding to go ahead with the investment, says Mike Evans, JD, chief risk officer and senior vice president. The $50 million covers the initial investment in technology, recruitment, software, and training.
The Sacramento facility is the first to employ the new technology. Sutter officials hope to have all of its 26 facilities tied in to the system in the next three years.
"This had to be weighed in with all the other capital requirements and demands placed on the system," he says, " but this one provided the greatest return for patient care."
Evans says one goal was to expand the availability of high-level care to patients in rural areas. Patients in some areas served by the Sutter Health network have difficulty accessing certain specialists, such as intensivists, because the local facility does not have the volume to justify hiring additional staff.
Sutter is banking on high-tech, remote access for the solution. In the newly wired ICU, vital signs and laboratory data from the sickest hospital patients are fed to existing on-site doctors and nurse stations as well as to a new, remote, specially equipped electronic ICU, known as the eICU. The eICU serves as a high-tech and centralized patient safety net with additional, full-time physician specialists and critical care nurses. The additional critical care support team provides another set of watchful eyes, constantly checking early warning indicators for vital sign changes and looking for any sign of trouble, says Sutter Health chief medical officer Gordon Hunt, MD.
"Medical studies have shown time and again that full-time intensivist coverage for ICU patients can significantly improve patient outcomes," he says.
The intensivist shortage
The challenge has been the nationwide shortage of intensivists. Fewer than 6,000 intensivists are actively practicing in the United States. Many communities, especially those in rural areas, do not have access to intensivists at all.
"This innovative technology will enable us to extend intensivist talent to the more than 400 ICU beds throughout our entire hospital network, complementing the high-quality care already provided by existing ICU physicians and nurses," he says.
California law requires that the patient provide separate consent for the use of telemedicine. Evans says he considered the potential malpractice risk of having physicians work with patients through a remote hookup, but he is comfortable that any risk is justified by the improvements in patient care.
"This system provides a level of expertise that is not otherwise available on a timely basis for this class of patients," he says. "It’s always after 5 p.m. and on the weekend when things go wrong. That’s when there’s no one around, the physician is home in bed, and he doesn’t want to be disturbed. With this new technology, people are always monitoring the patient and can respond immediately."
Nurses are still present in person in the ICU, but the physician can be contacted immediately. Through the remote hookup, he or she has immediate access to the patient’s data.
Here’s how the system works: ICUs throughout the Sutter Health network are being equipped with a video camera in each patient room, and with connections to computerized remote monitoring systems. On-site physicians, nurses, and other staff continue to provide on-site care in the ICUs. Critical care physician specialists and highly trained nurses also will staff a new remote ICU monitoring center, the "eICU." The eICU staff are linked to hospital staff by voice, video, and data technology. They will serve as a high-tech safety net for the most critically ill patients, providing an additional layer of monitoring around the clock.
Sutter Health president and chief executive officer Van Johnson says he expects other hospitals to make the same kind of advance in the near future.
"Sutter hospitals already have stringent quality control guidelines, but these proven technologies will provide us the opportunity to take patient safety to the next level," he says. "These high-tech support systems are the future of health care."
Hospitals within the Sutter Health network also will begin applying advanced technology to administering patient medications at the bedside. A computer bar code on each patient’s identification bracelet will be used to match and monitor the medication ordered by the doctor. Before administering medications, nurses and other caregivers will scan a bar code imprinted on the patient’s armband, and on the medication, using a hand-held device. A bedside computer will then read these bar codes into a software application that uses expert databases to provide patient-specific information.
This new system helps ensure the right dose of the right medicine is given to the right patient at the right time. It also alerts the clinician to possible allergies, and lookalike/soundalike or high-risk drugs.
"Bar coding is going to significantly improve the checks and balances," Evans says. "The system identifies who is giving the drug, the patient, and makes sure you have a good match there. But it also has parameters that will flash warnings when it foresees a problem."
Evans says the nursing staff is excited about the new technology and eager to use it. He expects the bar coding to reduce medication errors and near misses. "This will take the burden off the nurses so they don’t have to remember all the thousands of adverse interactions that can happen," he says. "It’s not going to eliminate the decision to make medication decisions at the bedside, but it will help them remember that there are decisions to make."
A California not-for-profit hospital is spending $50 million on new, advanced technology that promises fundamental changes in hospital ICU care and bedside medication delivery, all intended to improve patient safety.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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