Imagine hospital employees who could interact with multiple patients, diagnose and treat their illnesses, administer drugs, and even ensure medical staff is following infection control best practices 24 hours a day, seven days a week, all without getting out of their chair.
This is the basic premise of the eICU, an electronic subdivision of the ICU at Alegent Health in Omaha, NE. Mark Kestner, MD, senior vice president and chief medical officer at Alegent Health, likens it to an air traffic control tower. Nurses and physicians staff an offsite location filled with two-way cameras linked to ICUs in three metropolitan hospitals and one rural hospital within the system. Six nurses in the eICU routinely manage 15-20 patients each, in conjunction with on-site ICU staff members. A physician handles high-risk patients, and recently Alegent has added a pharmacist to monitor antimicrobial activity.
The software built into the eICU not only feeds real time data for roughly 100 patients, including vital signs, laboratory tests, cultures, and pharmacy data; it also sorts the information and sets off alerts if there are concerns with a patient. Doctors and nurses in the eICU can also alert bedside medical staff if a patient needs emergency care.
"What it does is it frees up the bedside staff because they know that certain elements of information are being sorted and addressed and that they can then be more available for the immediate needs of the patients or the routine bedside needs of the patient," Kestner says.
But from an infection control perspective, it also provides a window to monitor compliance and effectively implement infection prevention bundles in a unit that is notoriously battling infections.
Involving IC
In its first two years, the eICU at Alegent has focused primarily on patient care, but Emily Hawkins, RN, BSN, director of infection control at Alegent Health, says the centralized location of the eICU makes it a great opportunity to integrate infection prevention compliance as well.
Hawkins says there are plans to use the eICU to build antimicrobial reviews, which will forward information to the lab and pharmacy. In the future, an infectious disease physician will be present to intervene with antimicrobial counsel.
"I think what this allows us to do is to standardize our compliance with ventilator bundles and with standards of care," Kestner says. "We already had a very low infection rate, but this allows us to have another set of eyes on the team asking very specific questions every day."
You’re on candid camera
If this sounds a bit too "big brother" for you, you’re not alone. Kestner says ICU staff members were initially resistant to the idea of someone watching over their shoulder from a well-placed camera.
The clinical practice committee that oversees the eICU, made up of five medical executive committees, hospital presidents, and vice presidents, created a set of rules to alleviate that big brother feeling, including:
When the camera clicks on in a patient room, a bell rings to alert the on-site employee that the camera has been turned on
Twice a day, the on-site nurse and the eICU nurse conducted interdisciplinary care rounds with the patient and their family, which fosters a working relationship between the bedside staff and eICU staff
"It took us sort of actively intervening and teaching people how to act as a team in order to establish that relationship and not feel like the presence of eICU is intrusive; the presence of eICU is really being a part of their team," Kestner says.
This process even elicited praise from Department of Health and Human Services Secretary Kathleen Sebelius when she visited to experience this interaction first hand during a visit to Alegent’s Lakeside Hospital last month.
Absorbing the cost
Of course, as with any elaborate technology, the eICU comes at a hefty price. Kestner acknowledges Alegent was only able to integrate their rural hospital because of a USDA Rural Development grant.
Some might argue that having that extra set of eyes, 24 hours a day, seven days a week, will decrease infections, length of stay, and shorten patient days throughout the unit, which ultimately benefits the hospitals financials. But Kestner says it’s certainly worth it from a patient satisfaction and efficiency perspective.
"I think the way we are looking at it is length of stay for the whole hospitalization, shortening length of stay in the whole ICU, shortening length of stay on the ventilator," Kestner says. "We just have our baseline data, so I’m not sure we can say we have absolutely saved enough money to offset the initial expense, but it allows us going forward remain efficient."
The Association for Professionals in Infection Control and Epidemiology (APIC) urged healthcare organizations to mandate that staff members in direct contact with patients are vaccinated during the upcoming flu season.
The group made its recommendation earlier this week as predictions continued to surface about the number of Americans who may be infected with the H1N1 virus during the upcoming flu season. Last week, a presidential panel estimated that up to half of the U.S. population could become infected, and 1.8 million people could become hospitalized, resulting in up to 90,000 deaths. APIC issued a similar recommendation during the 2008-2009 flu season.
"Immunization will be especially critical for healthcare personnel during the 2009-2010 flu season because we will have more than one virus circulating," says Christine J. Nutty, RN, MSN, CIC, president of APIC. "All healthcare workers, including those who are pregnant, need to be immunized against seasonal influenza and 2009 H1N1 virus when vaccines become available. This is vitally important to healthcare worker and patient safety."
APIC issued a similar recommendation during the 2008-2009 flu season. Currently, rates of healthcare provider vaccination hover at the 42% mark, which has not budged much in the last 10 years. The Centers for Disease Control and Prevention, as well as APIC, recommend that all healthcare workers in direct contact with patients get a flu vaccination to keep patients safe. However, some staff members employed at private organizations see mandatory vaccination requirements as infringements on privacy.
One health system that is requiring all staff members are vaccinated for the seasonal flu by November 1 is Marshfield (WI) Clinic. Mandating vaccination for H1N1 hasn't been discussed and won't be until the CDC confirms there will be H1N1 vaccine available, says Bruce Cunha, RN, MS, COHN-S, manager of employee health and safety.
Because Marshfield, which is a clinical system, is made up of 45 facilities and serves more than 7,000 employees, the leadership team wanted to make sure that as many staff members as possible are vaccinated, he adds.
"This year [the executive committee] decided they wanted all employees [who] can be vaccinated to be vaccinated," says Cunha. "Persons with a medical condition that preclude them from being vaccinated would be excluded, but need to wear an isolation mask during the flu season while at work."
In the past, Marshfield has encouraged employees to be vaccinated during the flu season, offering educational programs and incentives. The facility even created a humorous educational video to get staff members on board with receiving the vaccination. Although the employee vaccination rate for the seasonal flu did increase, the rate had not met the administration's goal.
"This is a patient-centered policy in that we're an advocate for patient safety and we want to provide as safe an environment for our patients and employees as we can," says Cunha. "We know that vaccination of as many employees as we can is part of that safety effort."
APIC wants facilities to take a step further by obtaining informed statements from employees who decide not to vaccinate themselves for nonmedical reasons, acknowledging that their actions put patients at risk.
"Employees who are not vaccinated can transmit both seasonal flu and H1N1 virus to vulnerable patients in healthcare institutions," said Nutty. "Current rates of healthcare worker immunizations are appallingly low and must not be tolerated. It's time for hospitals to require flu shots—and hold employees accountable for declining the vaccine."
President Obama plans to address a joint session of Congress in an effort to rally support for healthcare legislation as White House officials look for ways to simplify and scale back the major Democratic bills, lower the cost, and drop nonessential elements. Administration officials said that President Obama would be more specific than he has been to date about what he wants included in the plan.
Massachusetts officials unveiled plans to tighten their oversight of pay and other practices at nonprofit healthcare companies in Massachusetts. The initiative was outlined by Massachusetts Attorney General Martha Coakley's office, which regulates nonprofit and charitable health organizations, in a memo to the state's major health insurers and a trade group representing hospitals.
A Fulton County, GA, Commission agreed to come to the aid of cash-strapped Grady Memorial Hospital with $10 million officials say is needed for the hospital to meet payroll next month. Grady CEO Michael Young said without immediate cash from Fulton, the hospital's line of credit with Wachovia Bank would be used up by mid-October and the system's tenuous financial condition would collapse. Young complained Fulton County had not paid Grady for indigent care since May, leaving the hospital more than $10 million short.
The debate over healthcare has included a host of accusations from opponents of the plan, with many in the mainstream news media labeling these accusations false. Many leading conservative healthcare policy experts say that the dynamic was precluding a more robust real-world debate while making it nearly impossible for them to inject their studied, free-market solutions into the discussions. And they said the focus on misleading or secondary issues was getting in the way of real questions about the plan, according to this article in the New York Times.
In the national debate over healthcare, doctors and policy makers often point to spending on defensive medicine as a key driver of soaring costs. But calculating how much defensive medicine actually costs is extremely difficult, because medical professionals often have many motivations for ordering tests and other procedures. And healthcare experts say the direct costs of medical malpractice—the insurance premiums, claims paid, and legal fees—amount to a very small portion of overall healthcare spending, according to this article in the Wall Street Journal.
Doctors concerned about the care of chronic kidney failure patients hope to meet this month with the chief medical officer of the Centers for Medicare & Medicaid Services to explore how it can be improved. In June, a group of leading nephrologists voiced concerns in a letter to Barry Straube, the top CMS doctor, and White House health policy czar Nancy-Ann DeParle. The letter urged "substantial changes in the delivery and financing of care . . . to improve patient outcomes."
Minnesota doctors were paid thousands of dollars in speaker fees and other payments in 2008 by a pharmaceutical company now implicated in a congressional investigation for its aggressive promotion of a popular antidepression drug, according to documents filed with the state and analyzed by a nonprofit group. Forest Laboratories Inc. paid 62 Minnesota doctors at least $1,000 each in speakers' fees, with 28 physicians receiving payments of more than $10,000, according to The Pew Prescription Project.
President Obama and his team were concerned that if the healthcare reform debate extended into the summer recess it would be difficult to get a bill across the finish line by the fall. And now, their greatest concern has become a reality, says says Sg2 Chairman and CEO Michael Sachs. Sachs says it is difficult to reform one-sixth of the U.S. economy with one piece of legislation because there are so many vested interests, each with its own needs and wants.
