The Hospital of Central Connecticut has announced a commitment to air quality standards and diminishing its environmental impact by implementing waste stream solutions.
The initiatives are implemented with Stericycle, which provides the hospital's medical waste disposal and other services, and focus on reusable sharps containers, proper pharmaceutical waste disposal, and overall recycling efforts.
In May, the hospital will launch Stericycle's Pharmaceutical Waste Disposal Program, aimed at keeping certain medications out of the environment. While the hospital has always followed current state and federal regulations on proper disposal of certain pharmaceuticals deemed potentially hazardous, research is revealing the potential detrimental effects of other pharmaceuticals not covered by regulations, HCC officials said.
"We wanted to make sure everything had its proper waste stream," says Tom Vaccarelli, senior director of facilities at HCC. "It's really the right thing to do with the environment."
Vaccarelli says these programs help HCC minimize the complexities of managing many of the hospital's waste streams. Along with a hospital's regulatory risk and associated costs, maintaining state and federal compliance and focusing on green outcomes are just a few objectives that these programs help HCC meet, he says.
"The regulations are very descriptive . . . and we had all of those items under control," Vaccarelli said. "It's more of the gray area stuff, or even the things that still aren't regulated but we know that number one, its the right thing to do, and number two someday they probably will get regulated."
Pharmaceutical waste can be complex and ultimately affects the nation's water supply if not disposed of properly. The waste must be characterized, segregated, and transported in compliance with EPA, DOT, and other regulators, HCC officials said.
"By handling it the right way and sending it out as a chemical waste, you've identified what it is, [and] it's managed the proper way," Vaccarelli says. "Once it's considered a waste, we manage it internally a certain way, it gets logged in, and stored a certain way, it gets transported a certain way—and ultimately either treated or disposed of a certain way."
The latest initiatives are part of the hospital's efforts to reduce waste and increase recycling, which began in 2004. HCC has also begun using reusable containers for all of its used sharps, such as needles and scalpels, to help keep plastic out of landfills, for example. The hospital expects in one year to prevent 27,553 pounds of carbon emissions by diverting 47,008 pounds of plastic and 2,508 pounds of cardboard from landfills.
The hospital has also established a "green team" that continues to explore avenues that will help HCC reduce its impact on the environment, Vaccarelli adds.
"By using these types of programs, the hospital is driving environmental best practices, staying ahead of regulatory compliance, and reducing costs," Vaccarelli says. "We intend to reinvest these savings in more healthcare programs that benefit our patients, staff, and the community."
A survey of 200 senior U.S. hospital officials found that in the face of sometimes severe budget constraints, providers across the country are employing sophisticated budget strategies to cut costs, making targeted investments to support growth, and emphasizing patient safety—all while preparing for the ramifications of new healthcare legislation.
The LEK Hospital Purchasing Survey was conducted in January 2010, and included 203 officials from hospitals across the United States. Individuals participating in the survey included CEOs, CFOs, COOs, materials managers, and purchasing directors. LEK Consulting officials said the survey was a response to healthcare market changes in the past few years.
"There's a combination of difficult economic times and a lot of uncertainty around government regulation in the industry," says Lucas Pain, vice president of LEK Consulting. "Our hope was to get a better understanding of how hospital administrators are managing the change and positioning themselves for success in the future."
The survey found that nearly two-thirds of hospitals decreased or froze spending last year, and most hospitals expect further cuts in 2010. These budget pressures have led to more aggressive negotiations with suppliers and payers, delays in facilities upgrades, capital expenditure freezes, longer equipment replacement cycles, and staff reductions, the survey found.
But despite these constraints, virtually no respondents cut their patient safety infection control budgets in 2009, and spending growth in these areas is expected in the future.
"As hospitals plan to differentiate themselves, patient safety will continue to be a key component of any initiative to establish a market niche or to enhance its reputation," Pain says. "Additionally, many insurance agencies are talking about reducing reimbursement for issues that can be attributed to patient safety, such as infections, that can be prevented."
Surveyed hospital executives anticipate that federal health reform will drive an increase in services and admissions for some areas, after observing a decline in both categories over the past 12 months. Other findings in relation to healthcare reform include:
While hospitals predict reform will lead to increased overall admissions, they say many elective procedures will decrease.
Senior executives believe the replacement of existing capital equipment and/or medical instruments is a catalyst for increases in current and future spending.
"New healthcare reform is dramatically changing the healthcare industry, and hospital executives realize that old business models no longer apply in today's healthcare landscape," says Jeffrey Stevens, vice president and co-head of LEK Consulting's global MedTech practice.
Also in relation to health reform, more than 90% of hospital purchasers believe that it will lead to increased IT spending as the need for physician order entry and EHRs increase.
Healthcare IT was indentified as one of the key areas in which hospitals have been increasing spending, and most respondents expect to increase their IT investments through 2014. Healthcare IT can also enhance patient monitoring and safety initiatives, which further supports the expectation of increased IT spending, Pain says.
"Additional IT systems will be put in place to both streamline operations and improve patient care," Pain says.
But while Stevens says that hospital executives are "cautiously optimistic" that their budgets will improve in the next five years, one size definitely does not fit all in the hospital budget process.
For example, supplies, purchases, and investments that are unlikely to generate significant short-term returns are more likely to be reduced or delayed.
"Not all departmental budgets are created equally within the hospital," Stevens says. "What we've seen is that hospitals have been making strategic trade-offs in the budget reductions on a department-by-department basis and that they are going to continue to make strategic trade-offs as budgets increase over the next five years."
To address these budgetary pressures, 61% of respondents said they were making focused budget cuts in specific departments. In addition, the survey found hospital executives have utilized multiple strategies to address budgetary pressures, including:
More than 80% are pursuing more aggressive supplier negotiations
70% are delaying facility upgrades
65% report freezing their capital equipment budgets or conducting more aggressive payer negotiations
58% are delaying instrument replacement, laying off staff, or instituting hiring freezes
And despite the uncertainty in the healthcare market, hospital executives have not stopped looking to the future, the survey found. Respondents noted that the most important unmet needs for providers include competitive differentiation, increasing patient safety, and improving patient outcomes.
The strategic initiatives that were deemed to be of top priority for respondents to meet these needs include outsourcing, the separation of specialized services, mergers and acquisition activity, and a focus on complete personal health for consumers.
"While it's well documented that the healthcare industry has been cutting costs, LEK's new research uncovered innovative strategies that begin to differentiate hospitals in select areas while simultaneously bracing to support the projected increase in admissions caused by new federal legislation," Stevens says.
Milton (MA) Hospital, an affiliate of Beth Israel Deaconess Medical Center, has entered a partnership with Sleep HealthCenters to develop a sleep medicine program that officials say is a response to increased awareness about how sleep deficiencies impact health.
Through the program, Milton has a sleep medicine clinic where patients with possible sleep disorders can meet with a specialist and get diagnosed for their affliction. There is also a diagnostic lab where people can sleep overnight if their symptoms warrant a sleep study. If a study is needed, staff observe the individual's sleep during the night and patients can have a follow-up visit on-site with sleep specialists.
"We've made it a comprehensive program where essentially it is a one-stop shop . . . rather than having patients seek out services elsewhere, it's meeting the needs of our community base," says Cynthia Page, PT, MHP, vice president of clinical and support services for Milton Hospital. "We're maintaining the service line within our hospital, so we definitely are increasing our capacity through a service line to meet the needs of our community."
Milton Hospital developed the sleep medicine program because of the need and physicians suggesting a program, Page says.
Sleep HealthCenters already operates a sleep lab with Beth Israel, and the partnership with Milton Hospital "was just a really good fit," says Paul Valentine, CEO of Sleep HealthCenters.
"We have programs that kind of surround that area, but aren't necessarily in that specific marketplace," Valentine says. "So it was a nice opportunity to work with them to build a stronger sleep program for that community. The concept here is to provide long-term care, to provide it all in one place, and to provide consistent follow-up."
In addition to conducting sleep studies, Sleep HealthCenters provides physician consults, patient monitoring, patient education, and follow-up care for Obstructive Sleep Apnea patients, including Continuous Positive Airway Pressure Devices.
Sleep HealthCenters operates several sleep medicine programs in New England. "In this case, Milton is billing for the program and helping to build the referral base, but we'll also help them market to their referral provider community, in addition to their patient community," Valentine says.
Both Valentine and Page say that sleep disorders have become quite prevalent in recent years.
Now that sleep problems are seen as contributing factors to diseases, such as obesity, cardiovascular disease, diabetes, and even strokes, providers are paying closer attention to how they can improve patients sleep patterns and, in turn, their well-being.
"One of the underlying reasons that really wasn't addressed for many years and is now addressed much more frequently is the fact that chronic sleeping disorders or deprivation could be part of the reason why a lot of those health concerns exist," Page says. "It's really getting back to identifying what the underlying pathology is for many of the chronic health ailments that we see in the patients that we serve."
Valentine agrees, adding that several societal trends has contributed to sleep disorders, including the obesity epidemic and the "plugged in" lifestyle that creates distractions to a good night's sleep.
He says that while sleep medicine has been around for a number of years, only recently has it received formal recognition by the medical community. Now that it is seen as a trigger for more serious problems more hospitals are taking notice and seeing that a sleep medicine service line can improve quality of care and is good business sense.
"The research has proven, and not necessarily surprisingly, that sleep has a significant impact on our health and our life, but at the same time we are also in an environment where the issues around sleep are growing," Valentine says. "The reality is, especially in the hospitals, many of the people they are dealing with have co-morbidities that are related to sleep as well—so adding it makes sense for their practice."
In response to both increasing market share and population in its service area, Ohio-based Summa Health System has announced a $65 million plan to grow its comprehensive emergency services network.
The plan includes the development of free-standing 24/7 emergency departments on the Summa Health Center at Lake Medina campus that is currently under construction, and in the city of Green to complement services offered at Summa Health Center at Green. In addition, the emergency departments at Summa Akron City Hospital, Summa Barberton Hospital, and Summa Wadsworth-Rittman Hospital will expand to allow for increased capacity—as well as improve the patient experience, said Summa.
"The bottom line for us is we've had a strategic plan for our emergency services network for years, and we're at this point where we are now representing five counties," says Summa Health System President and CEO Thomas J. Strauss. "So we announced a comprehensive plan to build our network of emergency services by building two new full-service emergency departments and expanding three existing ERs."
Summa's emergency departments saw more than 227,000 patients in 2009.
Currently, Summa Akron City Hospital's emergency department consists of 43 beds and approximately 19,000 square feet. The expansion at Summa Akron City will bring the number of beds to 75 and increase the size to 84,000 square feet, which Strauss says was a badly needed response to patient volume.
"It was designed to treat about 52,000 patients—last year we treated 78,000 in that space," Strauss says. "So for us, because it's Level 1 trauma, where there is only four Level 1 Traumas in all of northeast Ohio, we felt the need to really expand that in light of the comprehensiveness of services."
The expansion will include enhanced radiological testing capabilities with two radiography units, ultrasound, and a 64-slice CT scan unit dedicated to the emergency department.
In addition, the renovated facility will meet current and future patient needs, including additional capacity and private rooms that are large enough to accommodate families and loved ones at the bedside during the care process, Strauss says.
"What's exciting is it's going to include new amenities for patients that will enhance patient experience," Strauss says.
Plans are still being developed to expand and renovate the emergency departments at Summa Barberton Hospital and Summa Wadsworth Rittman Hospital. Also under development are the construction plans for the Summa Health Center at Lake Medina and Green emergency departments, which are both expected to open in 2011.
Strauss says these sites were chosen for construction and renovation because they either were areas where Summa already has a strong market presence and is looking to grow, or are regions where an increased potential patient base makes it attractive from a business standpoint.
For example, Strauss says that in Green, Summa has close to 60% of the market share. In Lake Medina, meanwhile, Summa has already invested "significant dollars" on facilities, such as medical buildings and physician practices for the Summa Health Center at Lake Medina that will open in the fall.
"This next phase of the ER will give us truly a comprehensive Level 4 ambulatory center in that region which will provide services into the community that maybe they haven't had before," Strauss says.
Not only is Summa bringing these services out to the communities, it makes good business sense for the system as well, he says.
"We also believe that the growth . . . will develop financial returns to the system to help support our mission to provide the highest quality, compassionate care and contribute to a healthier community," Strauss says.
Although there will be a staggered start to the construction and renovation projects, Strauss says they will all likely be done within the next 18 months. Summa's investment in these areas of Ohio will help bring comprehensive services to patients living there, he adds.
To meet increasing demand for pediatric care, Lehigh Valley (PA) Health Network has announced plans to establish a pediatric emergency department. The facility will be constructed in space adjacent to the current emergency department at Lehigh Valley Hospital Center-Cedar Crest in Salisbury Township, PA, and is expected to be completed in spring 2011.
Richard MacKenzie, MD, LVHN chair of emergency medicine, says the existing ED at LVH-Cedar Crest cares for 13,000 children a year. The demand for pediatric medicine at that location had reached a volume in which a pediatric ED was something to be considered, and LVHN would have had to expand the existing ED in a few years anyway to meet that demand, he says.
In addition, MacKenzie says there is no ED specializing in pediatric care in the Lehigh Valley region that is located on the eastern border of Pennsylvania.
"This service is not available to Lehigh Valley residents unless they drive over an hour east, west, or south," MacKenzie says. "Some of the Valley's children with complex illnesses do drive that distance to receive that service and we feel it would benefit them to receive the care closer to home."
Nationwide, an Institute of Medicine report in 2006 found that only about 18% of pediatric emergency visits are to a children's hospital or a general hospital with a pediatric emergency department. The report also said about 6% of U.S. hospitals have all the supplies to take care of children, such as pediatric endotrachial tubes and resuscitation equipment.
The 6,700 square-foot pediatric ED will include 11 treatment rooms and a separate waiting area for pediatric emergency cases. It will feature staff specially trained to care for children, including pediatric emergency medicine physicians, pediatric emergency nurses, and a child life specialist to assist children and their families with the psychological and social issues that sometimes result from an ED visit, MacKenzie says.
The purpose of the LVHN pediatric ED is to treat children as children, MacKenzie says. Many of the physicians will have completed a three-year fellowship in pediatric emergency medicine after graduating from either an emergency medicine or pediatrics residency.
"Of utmost importance is that all personnel will have a passion for treating children— they dedicate themselves to acquiring special knowledge necessary for that task" he says. "The chief philosophy will be to remain sensitive to children's and parent's needs."
A child-friendly atmosphere is critical, MacKenzie says, because it is often difficult for children to be in an environment where adults are suffering from illness or injury. From a disease standpoint, there are many illnesses that only affect children, and the new pediatric ED will put protocols in place to address these conditions, he adds.
The ED will feature special attention to employing state-of-the-art pain reduction methods, with a goal to manage a child's pain through staff education, consistent assessment criteria, implementation of protocols, and technology. There will also be a child life specialist on site to interact with the children and allay their fears. According to MacKenzie, research has shown severe pain and worry can stick with children for a long time, and even permanently.
"Innovation in pediatric care will reach the bedside faster here—the dedication to new knowledge in this specialty area will create the situation where this will occur," he says. "From a satisfaction standpoint . . . this will be a brightly colored, fun-looking space designed to lift one's spirit even in times of suffering."
MacKenzie adds that the creation of pediatric emergency departments at other U.S. hospitals has shown that a separate space for such treatment can further reduce wait times for both child and adult emergencies.
John Van Brakle, MD, LVHN's chair of pediatrics, says an emergency room dedicated to serving the needs of children is the next logical step for the network.
"We currently offer our young patients and their families access to a wide range of specialty care services, including a specialty care center, pediatric intensive care unit—the only one in the region—neonatal intensive care unit, and the most experienced trauma center in the region treating adults and children," Van Brakle said in a statement. "A pediatric emergency department would take the care of children, especially those with special healthcare needs, to the next level."
Proponents of The Hospital of Central Connecticut's newly available iPhone application that posts wait times at its facilities' emergency rooms say the information will improve both patient satisfaction and ED efficiency.
Every five minutes, the free iPhone app posts emergency room wait times at HCC's New Britain General and Bradley Memorial campuses. The app also provides maps and directions to the campuses, emergency room phone numbers, and general information about HCC.
"By letting people know what the wait is, we might be able to smooth demand and do ourselves a favor," says Jeff Finkelstein, MD, chief of emergency medicine at HCC.
"If we are behind at one campus, and no wait at the other, wouldn't it be nice if the patient selected the one with a lesser wait? It's a win-win: We set expectations and let people know, and on the backend maybe it's going to help us a little bit by smoothing demand."
In November, the hospital started listing emergency room wait times for both campuses on its Web site and on a flat screen television in the emergency room lobby at the New Britain General campus. The electronic lobby display also includes a rotating series of short messages with important information for patients.
HCC decided to post the information via an iPhone app for a variety of reasons, one being that a Flash player is unavailable on the iPhone so it is difficult to use it to find out the ER wait times from the Web sites, Finkelstein says.
"When you are mobile, with the iPhone it is a lot quicker to just press the icon button rather than try to get to the Web site," Finkelstein says. "You also have all the other benefits of an iPhone app: You have one button that will give you a map from where you are right to the front door of the ER, and with a push of a button you can call the ER right from the app."
The iPhone app also allows for easy access to other information about HCC and its individual campuses, including an "About Us" page that contains information on each of the ERs and what type of services are offered.
For example, pregnancy-related concerns are best served on HCC's New Britain campus where they employ an in-house, attending obstetrician 24 hours a day, seven days a week, Finkelstein says.
"I'm trying to give people information, so they don't go to Bradley if they have an OB complaint," he says.
By providing this information and making it readily available, Finkelstein says HCC can improve patient satisfaction. He adds that the number one concern of almost any patient visiting an emergency room is wait time.
With this information available at the press of a button, patients know what to expect when they have to make a trip to the ER and can plan accordingly.
"We don't think information hurts—people are only disappointed when they have expectations that aren't met," Finkelstein says. "We try to under-promise and over-deliver. If the wait is truly an hour, we're going to tell you an hour."
The wait-time app is not the only Web-based application in use at HCC. Under a partnership between HCC's New Britain campus and New Britain Emergency Medical Services, Inc., the Web-based LIFENET system helps speed treatment of patients having a ST-elevation myocardial infraction (STEMI). The system allows EMS to send an incoming patient's electrocardiogram reading to the hospital's ER.
Once an Emergency Department physician confirms a STEMI from the transmission that includes the patient's heart rate, rhythm, and electrical activity, an angioplasty suite can be immediately set up. The system's use can reduce angioplasty suite arrival time by about 30 minutes.
"With one touch of a button, they can forward the information to the iPhone of the on-call cardiologist—we are then able to view the EKG of the patient who hasn't even arrived yet in the emergency room on the iPhone," Finkelstein says. "If we can save time and get the process started before the patient even arrives in the ER, every minute we save is a better outcome for the patient."
Using Web-based applications, such as the ones incorporated at HCC, Finkelstein says healthcare providers can improve quality and patient relations across many areas of care.
"It's really become a management tool," Finkelstein says. "With one button, I can check the wait times and check the health of my department."
A new emergency department lobby at Portland, OR-based Adventist Medical Center is designed to help patients relax and relieve their anxiety while they wait.
The 2,500-square-foot waiting room was modeled after a hotel lobby, and features an oversized fireplace, plasma televisions, a family-friendly seating area, free Internet access, and multiple windows for natural lighting.
Tom Russell, CEO of Adventist Medical Center, says patients who come to the emergency department are under great physical and emotional stress, and the design of the new lobby can help alleviate these feelings.
"We believe it's important to treat the whole health of our patients and that we initiate the healing process the moment they walk through our doors," Russell says. "By designing a comfortable lobby area that encourages relaxation, we are able to help prepare patients and their families for treatment and expedite the healing process."
The lobby was designed in collaboration with Adventist physicians, who provided their input on how to help emergency patients relax. Other staff and members of the community also provided suggestions to Peterson Kolberg Architects as well.
Kelli Westcott, MD, vice-chair of emergency services for Adventist Health, says the emergency department is one of the few places in a hospital people do not make plans to visit. And when they do have to make a trip there, the patients sometimes face life-threatening problems that create a stressful environment.
"Families face stressful times of uncertainty during these visits," Westcott says. "Family members and patients alike benefit from the spacious, comfortable environment of the emergency department lobby."
Westcott says the philosophy of Adventist Health is based on whole-person care that includes caring for the patient's mind, body, and spirit. Although a person who arrives in the ED is typically filled with anxiety and fear, Adventist Health designed the new ED lobby so that a sense of calm and tranquility can be fostered the moment they walk through the doors.
As a result, it reduces further risks of stress and enhances safety, Westcott says.
"Our calming palate of colors, strategically designed fireplace, carefully chosen artwork, and comfortable furniture were selected for much more than an aesthetic purpose—these choices were made with the patient in mind," Wescott says. "This attention to detail is prevalent throughout the new pavilion, which also houses the Northwest Cardiology Center and expanded oncology services."
The nonprofit, 302-bed Adventist Medical Center serves the Greater Portland and Vancouver, WA, metropolitan area. Its emergency room treated more than 46,000 patients in 2009.
The opening of the emergency department lobby was one of Adventist's three-phase expansion. The first phase was a new 181,000 square foot medical pavilion that opened in May, which increased AMC's emergency department capacity by 33% and unveiled its Northwest Regional Heart Center. The other phase of the project expanded the hospital's emergency department to 32 beds.
Methodist McKinney (TX) Hospital, a joint venture between area physicians, Methodist Health System, and Nueterra Healthcare, has officially opened to serve residents in the growing Collin County region of north Texas.
The guiding principle during the hospital's development was to establish a community-based hospital in McKinney that would be a "destination medical center" for residents in the region, says Kevin D. Jones, president of Methodist McKinney Hospital. According to U.S. Census Data, in 2000, the population of Collin County was 491,675, and by 2008 the Bureau estimated that its population had reached 762,010—making McKinney an attractive area to establish the new hospital.
"Based on the feedback we received from local focus groups during development of the project, it was evident that area residents and, perhaps, prospective patients wanted another option for healthcare services in McKinney so they don't have to go to another city to receive care," Jones says.
The 65,000 square-foot facility includes six operating rooms, two procedures rooms, 22 pre-op/PACU bays and 15 private inpatient rooms. Services offered include surgical interventions in orthopedics, general surgery, ENT, neurosurgery, pain management, urology, gynecology, and GI.
Methodist McKinney also operates an around-the-clock emergency room, and an imaging department offering MRI, CT, ultrasound, and mammography services.
"The greatest benefit is the increased access to care for the residents of McKinney and the surrounding communities through our operating rooms, emergency department, and diagnostic imaging services," says Jones, who came to Methodist McKinney from Parkland Health & Hospital System in Dallas, where he served as director of Simmons Ambulatory Surgery Center.
"Our project brings together 31 physician investors and approximately 75 medical staff members to deliver care to a rapidly growing population in McKinney and Collin County."
The joint venture strategy that allows input from both Nueterra Healthcare and Methodist Health System is beneficial from both a business and quality-care standpoint, Jones says.
"Having Methodist as our health system partner not only affords us an advantage when negotiating supply costs, vendors' contracts, insurance contracts, etc., but it also gives the hospital immediate credibility with patients because of the system's strong brand in North Texas," Jones says. "Nueterra brings its extensive expertise in the successful development and management of smaller, surgically-focused hospitals."
But, he adds, that perhaps most importantly, both Methodist and Nueterra understand that the hospital's success is dependent upon strong physician leadership—and the joint venture structure incorporates that idea.
Physician partners significantly contributed to the design, look, and feel of the hospital, and the participation by physicians was a critical success factor given how in-touch the providers are with their patients and how educated the physicians are about evidence-based design principles, Jones says.
"From the architectural design to the interior color schemes to the artwork selections, the physicians and our Board of Managers were very involved in this process," he adds. "They wanted a hospital that did not look like a hospital and we succeeded in creating a truly unique patient-centered environment."
A "home-to-hospital" program in use at MassGeneral Hospital for Children uses real-time video communication that enables an on-call attending physician, from their home, to personally examine patients and communicate directly with staff, other specialists, and even the patients' relatives.
Through the Connected Pediatric Critical Care program, six Pediatric Intensive Care Unit physicians from MassGeneral currently have the videoconferencing units in their homes. When they are need to consult patients and families while away from the hospital, they can videoconference in from home to a portable telemedicine station at the patient's bedside.
"The physicians, nurses, and therapists at the bedside have felt better with the new system in place due to their ability to directly communicate with the attending physician, see him/her, and continue to do whatever is necessary to treat the patient while this communication is taking place," says Natan Noviski, MD, chief of Pediatric Critical Care Medicine at MassGeneral Hospital for Children. "The attending physicians at home feel that they actually can better help with the decision-making and management of the clinical scenario that triggered the call."
The new system includes a telemedicine station at the homes of each senior attending physician covering the PICU at night, and a mobile cart, nicknamed the PICUBOT, that can be moved from bed to bed as needed.
Using the telemedicine system, the attending physician can then see the patient, talk with clinicians on-site, personally evaluate the child's condition, and make treatment decisions. Special cameras and scopes can also be attached to the telemedicine station to allow for closer evaluation of the patient.
"From home, the attending MD uses a remote to control the camera located in the PICUBOT, which is stationed at the patient's bedside," Noviski said. "The team at the bedside can see the attending MD ins the screen of the PICUBOT."
In the past, during the night and on weekends, on-call attending physicians at MassGeneral Hospital for Children were traditionally contacted via telephone by the covering resident in the PICU. The attending physician would provide guidance, via telephone, without input from the rest of the team and without personally seeing the patient. The attending physician would also have to decide if it was necessary to return to the hospital.
Since the program launched in 2009, the Connected Pediatric Critical Care program has significantly improved the quality of care, team communication, and staff responsiveness during evening hours and weekends when attending physicians have left the hospital to home, Noviski says.
"With the old system … the attending at home did not have the ability to see the patient or have input from the other team members or from the parents, if they were at the bedside," Noviski says. "This system allows for a multidisciplinary communication based on being able to see the critically ill child rather than a 'blind,' two-person only conversation. This improved communication obviously benefits the patients as well."
The Connected Pediatric Critical Care program was launched at MassGeneral for Children in partnership with the Center for Connected Health, a division of Partners HealthCare. Boston-based Partners HealthCare is an integrated health system founded by Brigham and Women's Hospital and Massachusetts General Hospital, and the Center is designed to help providers develop innovative technology that can be implemented in the care setting.
"Videoconferencing is not new, but the application of this technology—connecting at-home physicians with their patients and the hospital-based medical team—is a novel and important advance in critical care medicine," said Joseph C. Kvedar, MD, director of the Center for Connected Health, in a statement.
The program creates a teaching opportunity as well, allowing residents to be more involved in a team approach that benefits the care environment, proponents say. It can also help parents feel more confident in the attending physician because it gives them more of an opportunity to interact with the doctor.
Kvedar and Noviski added that other intensive care units, for both adults and pediatric patients, could benefit from similar home-to-hospital telemedicine systems.
"If successful, this program can be incorporated into all of the ICUs and patient floors," Noviski says.
Philadelphia-based Friends Hospital has opened a 24-bed inpatient, acute care psychiatric unit based upon the principles of the "recovery model."
Under the recovery model, patients are assisted in re-forging ties with their community and families, as well as developing new hobbies and pursuits. They are counseled through peer-support specialists who have been through the process successfully. Friends Hospital's recovery-oriented unit is the first such unit in Philadelphia.
"It is so focused on the person's experience that it really allows us as a treatment team to make it the best experience for people in a difficult time," says Friends Hospital Chief Executive Officer Ken Glass, PhD. "It is growing nationally in recognition that recovery oriented approach produces better outcomes for people, particularly in the area of going back into hospitals in a short period of time."
Friends Hospital decided to develop the new unit after gathering feedback from former patients, thinkers in the field, stakeholders in the city of Philadelphia, its own staff, and literature on the recovery model.
Glass says the unit really was a new start "from top to bottom," and Friends closed one of its units for about six weeks as the new recovery unit was developed. One big change was the space was completely redesigned so it had more of an "at home" feel, Glass says.
"We took all this information and crafted what we believed a successful recovery oriented inpatient unit would look like," Glass says.
Upon admission to the new unit, each individual will be assessed to determine whether or not the recovery unit is suitable for his or her treatment. In the program, each patient will have individualized treatment catered to the individual's strengths and needs.
Friends Hospital staff will then create a collaborative, working relationship with each patient to identify goals to help them reach a successful recovery. The ultimate goal is for each patient to leave with a "new life plan" that incorporates a more individualistic approach to treatment that includes aspects such as their own support systems, hobbies, strengths, community connections, and goals.
"We're trying to marry our desire to both improve our patients' experience with some evidence out there of what approaches are effective," Glass says. "It really does give us a better picture of that person than a traditional psychiatric approach. What we consider it is really speaking to a person as a whole, and not simply their symptoms."
There are several main components to the recovery-oriented approach, Glass says: The first is to help people develop a life plan that goes beyond their psychiatric care that includes what their goals are in life beyond treatment.
The second part of the recovery model is to involve peers that have been through similar treatment and experiences.
"There are insights by people that have been through it that professionals really never have, and that can significantly influence both a person's experience in treatment and their planning for future treatment," Glass says.
The third way that the recovery approach is different than traditional psychiatric care is that the model tries to ensure that each patient has a network of friends and family members to help them through their treatment, rather than professional support only.
"Our goal is to identify people in their life that they can rely on and to have almost a commitment ritual with those people when the patient leaves, so it reduces the chance that they end up in crisis," Glass says.
Alternative therapies will be incorporated as well, including music, art, horticulture, and dance. A team of certified peer specialists will work closely with patients in the unit to share their own experiences and develop networks for aftercare.
Glass says that by incorporating all of these elements, the patient develops a "long-term emotional infrastructure" that will prove invaluable to their treatment.
"We help people identify the people in their life, the places, and things in their life that support them rather then have them back with people and in places that work against their success and recovery," Glass says.