HIMSS: Combining tele-ICU & transfer center reduces length of stay
ORLANDO, Fla.—Integrating the efforts of a tele-ICU and the transfer center can improve clinical care for emergent patients, resulting in “soft savings” for the provider and reduced length of inpatient stay, according to a Feb. 22 presentation at the 2011 annual Healthcare Information and Management Systems Society (HIMSS) conference.
Beth Willmitch, RN, operations director of the eICU LifeGuard at Baptist Health South Florida (BHSF) and Leslee Gross, RN director of the transfer center at Baptist Health South Florida, spoke about the decision to link the tele-ICU and the transfer center.
BHSF is a nonprofit, community health system with five acute care hospitals and a sixth opening in April, 11 urgent care centers and one tertiary care center, serving the Miami metropolitan area.
Importantly, the provider has 114 tele-ICU beds, which are covered by one physician, three nurses and one secretary on a 24/7 basis. The transfer center is located in the same room as the tele-ICU, which was initially done because of access to the 24/7 physician.
The BHSF transfer center is “unique in that it is not only an input facility, but also allows output,” said Gross. “The purpose of the transfer center is to make your transfers more efficient, to streamline all resources into one place and have all the experts in one place, which will result in an enhancement of patient care.”
The transfer center is a “one-stop shop for transfers,” Gross said, resulting in a “more efficient transfer process for bedside caregivers, reducing the process to one call to the transfer center and freeing up these human resources for direct patient care, leading to improved hand-off communication between sending and receiving physicians.”
Willmitch explained that tele-ICU, or e-ICU, was a concept created by two physicians at Johns Hopkins University Hospital in Baltimore, mainly due to the shortage of intensivists in the U.S. Across the U.S., they determined that 25,000 critical care physicians were needed and only 6,000 existed. Under this model, one critical care physician can remotely monitor multiple locations using existing technologies.
Because only one of five BHSF hospitals has a 24/7 intensivist in the ICU, the provider began its tele-ICU in late 2005 to “improve utilization of scarce resources—the critical care physicians and nurses, standardize ICU care across our health system, improve quality, and reduce mortality and length of stay,” according to Willmitch.
The caregivers also can tap into the network, to gather real-time monitoring of vital signs. “Exactly what the nurse sees at the bedside, the decision maker can see remotely,” Willmitch said. Plus, there is a color-coded alert system that makes the care givers aware if anything is wrong with the patient.
At Baptist Health, the tele-ICU is located remote from any hospital campus and patient data are interfaced to tele-ICU application (ADT, lab, pharmacy and real time vital signs) to the physician. “All hospitals are moving toward complete EMRs, and until that process is complete, the tele-ICU staff is relying upon bedside to fax or scan progress notes to the physician,” Willmitch explained.
Also, the bedside staff uses a tele-ICU application to document vital signs, continuous infusions and I&O. The tele-ICU physicians and some other hospital based physicians also use tele-ICU applications for progress notes. Then, all documents created in tele-ICU application are electronically sent to the medical record.
Finally, a two-way monitor allows the physician, nurse and patient to communicate more naturally, and “see who they are talking to,” Willmitch said.
Using an APACHE methodology, the provider assessed its severity-adjusted mortality and length-of-stay ratios, but reversed the methodology to examine the number of lives saved and days in the hospital saved. In the 2010 second quarter, Baptist Health saved 102 lives that APACHE predicted would die. Similarly, the ICU days saved hover at just about 1,000, and the hospital days saved are calculated between 2,000 and 2,500.
“Calculating these days into dollars, we figured the average cost of an average ICU day was $2,500. Therefore, in 2010, we saved a little more than $10 million,” said Willmitch, who acknowledged that these calculations are a “soft savings” because it’s hard to attribute all of it to the tele-ICU program.
By integrating the efforts of the tele-ICU and the transfer center, it resulted in real-time situation awareness, comprehensive continuity of care and advice on the transfer, according to Gross. The additional benefits for the integration of these services allowed constant physician availability to the transfer center, coordinated consultation and consistent processes, she concluded.
For future initiatives, the provider is looking into a telestroke program, e-consultation, international consultation, outreach programs and e-pharmacy programs.
Beth Willmitch, RN, operations director of the eICU LifeGuard at Baptist Health South Florida (BHSF) and Leslee Gross, RN director of the transfer center at Baptist Health South Florida, spoke about the decision to link the tele-ICU and the transfer center.
BHSF is a nonprofit, community health system with five acute care hospitals and a sixth opening in April, 11 urgent care centers and one tertiary care center, serving the Miami metropolitan area.
Importantly, the provider has 114 tele-ICU beds, which are covered by one physician, three nurses and one secretary on a 24/7 basis. The transfer center is located in the same room as the tele-ICU, which was initially done because of access to the 24/7 physician.
The BHSF transfer center is “unique in that it is not only an input facility, but also allows output,” said Gross. “The purpose of the transfer center is to make your transfers more efficient, to streamline all resources into one place and have all the experts in one place, which will result in an enhancement of patient care.”
The transfer center is a “one-stop shop for transfers,” Gross said, resulting in a “more efficient transfer process for bedside caregivers, reducing the process to one call to the transfer center and freeing up these human resources for direct patient care, leading to improved hand-off communication between sending and receiving physicians.”
Willmitch explained that tele-ICU, or e-ICU, was a concept created by two physicians at Johns Hopkins University Hospital in Baltimore, mainly due to the shortage of intensivists in the U.S. Across the U.S., they determined that 25,000 critical care physicians were needed and only 6,000 existed. Under this model, one critical care physician can remotely monitor multiple locations using existing technologies.
Because only one of five BHSF hospitals has a 24/7 intensivist in the ICU, the provider began its tele-ICU in late 2005 to “improve utilization of scarce resources—the critical care physicians and nurses, standardize ICU care across our health system, improve quality, and reduce mortality and length of stay,” according to Willmitch.
The caregivers also can tap into the network, to gather real-time monitoring of vital signs. “Exactly what the nurse sees at the bedside, the decision maker can see remotely,” Willmitch said. Plus, there is a color-coded alert system that makes the care givers aware if anything is wrong with the patient.
At Baptist Health, the tele-ICU is located remote from any hospital campus and patient data are interfaced to tele-ICU application (ADT, lab, pharmacy and real time vital signs) to the physician. “All hospitals are moving toward complete EMRs, and until that process is complete, the tele-ICU staff is relying upon bedside to fax or scan progress notes to the physician,” Willmitch explained.
Also, the bedside staff uses a tele-ICU application to document vital signs, continuous infusions and I&O. The tele-ICU physicians and some other hospital based physicians also use tele-ICU applications for progress notes. Then, all documents created in tele-ICU application are electronically sent to the medical record.
Finally, a two-way monitor allows the physician, nurse and patient to communicate more naturally, and “see who they are talking to,” Willmitch said.
Using an APACHE methodology, the provider assessed its severity-adjusted mortality and length-of-stay ratios, but reversed the methodology to examine the number of lives saved and days in the hospital saved. In the 2010 second quarter, Baptist Health saved 102 lives that APACHE predicted would die. Similarly, the ICU days saved hover at just about 1,000, and the hospital days saved are calculated between 2,000 and 2,500.
“Calculating these days into dollars, we figured the average cost of an average ICU day was $2,500. Therefore, in 2010, we saved a little more than $10 million,” said Willmitch, who acknowledged that these calculations are a “soft savings” because it’s hard to attribute all of it to the tele-ICU program.
By integrating the efforts of the tele-ICU and the transfer center, it resulted in real-time situation awareness, comprehensive continuity of care and advice on the transfer, according to Gross. The additional benefits for the integration of these services allowed constant physician availability to the transfer center, coordinated consultation and consistent processes, she concluded.
For future initiatives, the provider is looking into a telestroke program, e-consultation, international consultation, outreach programs and e-pharmacy programs.