IT to the ED, STAT!
Bottlenecks in the emergency department (ED) can send physicians scrambling to prevent chaos while striving to provide optimal patient care. Automated patient tracking, thin-client dashboards, pre-hospital cardiac triage systems and emergency department information systems are helping ED physicians do more of the former while preventing the latter.
Together, they also are truly building sustainability, proving that IT can pay its own way by reducing out-of-pocket and labor costs.
ED-focused IT technology can shrink “delay loops,” says Craig F. Feied, MD, chief health strategy officer at Microsoft, and professor of emergency medicine at Georgetown University in Washington, D.C. Just getting the right patient information into a physician’s hands at the right time can minimize patient wait times, shrink costs and improve the process of care, Feied says.
“Any solution that can decrease the time that you have to spend in the ED is better for patient care, patient safety and patient satisfaction,” agrees Michael L. Westcott, MD, CMIO at Alegent Health in Omaha, Neb.
‘Time is muscle’
Cardiac care can begin well before patients enter the emergency department at Banner Del E. Webb Medical Center in Sun City West, Ariz. The 404-bed facility, which treats about 53,000 patients in its emergency department each year, is collaborating with Fire Station 301 in the city of Surprise, Ariz., on a 12-lead EKG pilot program for heart attack patients using Physio-Control’s LifePak 15 monitor and Lifenet software. The program began March 1.
With the push of a button, an EMT can transmit patient information directly to hospital staff within five minutes of encountering a patient. A hosted client application—Medtronic Lifenet Blue—allows data to be transferred wirelessly from the LifePack 15 to the hospital, where physicians can analyze patient data in real time.
The Lifenet application can transmit data from up to 100 meters away from the LifePak monitor unit, and eliminates the need for bulky infrastructure and IT maintenance because the system is managed by Medtronic. Lifenet software can be installed on up to five PCs using any standard internet port. In addition to workstations or laptops, patient data including vital signs, heart rhythms and detailed charts can be linked to a physician’s smart phone or PDA, potentially beginning the process of care even earlier.
“The scalability, flexibility and lack of footprint in the ER are advantageous,” says Nathan Lewis, pre-hospital coordinator at Banner Del E. Webb Medical Center. “We are not taking up desk space; data are going on a PC that’s already there with no need for the management of the infrastructure.”
Since the program’s launch, Station 301 has treated 18 patients with chest pain, including the early diagnoses of two ST-segment elevation myocardial infarction (STEMI) patients. “Right out of the box, we are seeing 100 percent transmission of data of all of our 12-lead patients,” Lewis says. Before the pilot program, the average transmittal rates for chest pain patients were 12 to 25 percent, Lewis says.
Banner’s goal is to perform a 12-lead ECG within five minutes of patient contact, but the staff would like to lower these times to three minutes, he says, because of the promising results the facility has already seen. The 10- to 15-minute savings in treatment times made the difference between life and death, he says.
“Time is muscle,” he says. “If we can get this information into the cardiologist’s hands in that period of time, that’s huge.”
Closing the loops
As a former director of informatics at the 926-bed Washington Hospital Center in Washington, D.C., part of MedStar Health, Feied saw—one delay in care leading to others—delay loops lead to negative outcomes. He observed that if an IT system were available to recognize problems sooner, physicians could treat patients before a code blue situation arose.
Feied and colleague Mark Smith, MD, created the Amalga Unified Intelligence System (UIS) in 1997 to address this need. Amalga, which was first deployed at the Washington Hospital Center, encompasses data from hundreds of systems across the hospital enterprise to provide instant access to patient information. Feied says the UIS was refined during the next 10 years and was purchased by Microsoft in 2006 under the name Azyxxi.
In 30 percent of patient cases at Washington Hospital Center, Amalga spotted trends, patterns and outliers in data that changed the process by which physicians provided care, ultimately leading to better patient outcomes, says Feied.
Prior to the deployment of Amalga, Washington Hospital Center treated 38,000 patients annually in the ED. After deployment, these rates skyrocketed to 80,000 patients, says Feied, due to a reduction in patient complications and shortened length of stay.
Seeing trouble before it escalates is the name of the game, Feied notes. “Most of the time in the ED, you don’t see problems until you are pushing the panic button and you’re already headed for a crash landing. If everybody in the hospital can see that a situation is getting worse and alert systems or trend lines are visible, suddenly everybody can mobilize,” he says. “This can make a huge difference in patient throughput not only in the ED, but throughout the whole hospital.”
Seamless transitions
Alegent Health encompasses a broad range of care facilities in Iowa and Nebraska, including nine hospitals and eight rural and metropolitan EDs. With 9,000 employees and more than 1,300 physicians, Alegent’s metro EDs average 18,000 patient admittances per year. Alegent has seen an upswing in its ED patient volume and medication and testing orders and acuity, but reported a lag in dictation and transcription turnaround times. Westcott attributed this lag to Alegent’s prior documentation process, which relied on paper templates and some dictation. For years, Alegent’s EDs used a combination of IT devices that didn’t meet the needs of the department, he says. The health system began looking for cost-efficient products that provided quick access to patient information, consistent workflow and mobility, and addressed HIPAA concerns.
About 10 months ago, Alegent began installing ThinIdentity’s Sun Ray 270, a virtual thin-client display, and the Picis ED PulseCheck, an emergency department information system (EDIS), says Westcott. The ED was already using Picis’ SmarTrack patient tracking board, but hadn’t used its automated documentation software.
The virtual display/EDIS combo provides thin-client monitors with smart-card readers at each workstation. “With this system you don’t have to designate certain computers for certain personnel,” Wescott says. “Every employee can use any device just by inserting his or her card.” Smart cards enable employees to pull up patient information on one workstation, log on to another workstation in another area, and pick up their session where they left off, without having to log in again or re-authenticate. “The session roams with you,” says Westcott.
Since deployment, Alegent has seen a 10 percent drop in ED patient throughput times—the time from when a patient enters the ED to the time he or she is admitted or discharged. In addition, the system allows clinical orders to be placed immediately, says Westcott.
The PulseCheck EDIS integrates patient information and CPOE systems, MedScan bedside bar-code scanning, and paging, printing and the web to manage care and clinical documentation.
Smart cards and patient tracking boards allow constant patient monitoring, alleviating gaps in care and prolonged wait times. In addition, individual documentation by physicians reduces communication catastrophes that previously occurred when placing orders through a second person. “Patients don’t have to sit for an hour because someone forgot to call the radiology department,” he says.
While the initial costs of the infrastructure were high, says Westcott, “we are able to not only see a hardware savings, but people savings, because the technology alleviates the need for computer technicians on the back end.” Sustainability has been achieved.