Special Safeguards for Critical Care New technologies are advancing safety and helping clinicians. February 1st, 2004 by Mark Hagland Patient safety innovations are transforming how care is delivered in intensive care units (ICUs) and operating rooms (ORs), and it's about time, say industry observers and clinician leaders. The majority of costs, staffing and patient safety issues are focused in these high-morbidity, high-intensity areas. Advocate Health Care, Chicago, is involved in such patient safety initiatives, with 19 ICUs in eight of its hospitals participating in implementation of a new concept called the "eICU®." Using technology from Baltimore-based VISICU Inc., intensivist physicians based at Advocate system headquarters in Oak Brook, Ill., are remotely monitoring the ICU patients. If vital signs or other indicators point to sudden changes in condition or other problems, they can intervene immediately, contacting clinicians at the indicated ICU or writing orders. In many cases, minor adjustments can be made directly from the remote monitoring site. "The sickest patients in the hospital are in the ICU and have the highest level of mortality--10 to 14 percent," explains Michael Ries, M.D., the intensivist who manages the eICU® in Oak Brook. And the ICU accounts for 30 percent of costs, even though it represents only 8 to 10 percent of beds in the average hospital. The bedside technology also addresses the nationwide problem of a critical shortage of both intensivists and highly qualified ICU nurses. Advocate's flagship hospital, Lutheran General, rolled out its eICU® in late April last year, with others gradually added into the fall and winter. Over the several months, Ries and his colleagues have seen a measured decrease in mortality, "not to mention the number of complications and adverse drug reactions we've picked up just by monitoring the patients more closely." Other health systems implementing similar eICU® programs have had comparable success. Norfolk, Va.-based Sentara Health System reports reductions of 25 percent in mortality among critical care patients and of 20 percent in costs and length of stay. Such gains aren't surprising, says VISICU's CEO Frank Sample, who has headed a variety of healthcare IT companies. "This is unequivocally the most exciting thing I've come across since I've been in healthcare--for 17 years." OR of the future? The Institute for Technology Assessment at Massachusetts General Hospital, Boston, is implementing various patient safety-oriented technologies in a project called the "Mass. General Operating Room of the Future." Begun two years ago, its purpose is to evaluate new technologies and processes in the surgical environment. One OR (of the hospital's approximately 50) has been set aside as a test/beta site. "It's a functioning operative room," says senior scientist James Stahl, M.D., an internist and the principal architect of the study. "So it has to be safe and efficient enough to actually work and treat real patients." Location software from Radianse, Lawrence, Mass., is one of the technologies Stahl and his colleagues have been testing. It uses radio-frequency and infrared waves in its indoor positioning system devices, which resemble automobile door-opener fobs (the kind with transponders in them). Among the tremendous patient safety opportunities in this software, points out Radianse president and chief technology officer Michael Dempsey, are the ability to exactly locate a patient in the hospital and to quickly track down equipment that may be urgently needed. Or "You can use this for a bag of blood, for example," he notes, "and use it for matching, so if the bag doesn't match the patient's blood type, it sets off an alarm." Extra benefits Such technologies are clearly the kinds of things the Institute of Medicine, Washington, D.C., is trying to direct hospitals to acquire and implement for improving patient safety and reducing medical errors. Massachusetts General clinician executives have already decided to deploy their positioning system in all 50 ORs in four buildings. Advocate Health Care expects eventually to roll out its remote-monitoring solution to all of its ICUs. Advocate's Ries reports an added benefit in the physically challenging environment of the critical care unit: It has allowed the organization to attract more ICU nurses and "is helping some of the most experienced nurses to extend their careers and extrapolate their experience to younger nurses." And, he says, "For myself, I look at it as helping me be a 'super-intensivist.' I can take my experience and extrapolate it to 75 patients, not just 10."