Tuesday, May 12, 2015

Intensive care from afar: Caregiver versus patient watcher

File:US Navy 030423-N-6967M-090 A central computer system monitors the heart rates of each patient in the Intensive Care Unit (ICU) to ensure a quick.jpgA recent NPR story by Michael Tomsic recounted the remarkable story of how the Carolinas HealthCare System monitors ICU patients in 10 of its hospitals from a remote "command center"-like facility. Several critical care specialists staff the center; nurses are present around the clock and doctors work nights. Command center staff also spend time at the hospitals they monitor.

The system began doing this roughly two years ago and have since found that the quiet atmosphere of the command center ("none of the bells and whistles going off that most ICUs need to alert nurses and doctors down the hall that they're needed") allows medical staff in the center to maintain a constant focus on patients. The approach seems to be working for the system: They've observed a higher patient volume, lower mortality rate, and decreased length of stay since opening the center (though, as the article describes, such improvement likely isn't due solely to the remote monitoring program).

The issue of alarm fatigue is recognized as an important patient safety issue, so the idea of placing a group of specialists outside the immediate patient environment for monitoring purposes has a strong rationale. What I found most interesting about the article, however, was revealed in remarks from two nurses interviewed. One observed that "There are things that I'm able to view here [in the command center] — trends that I'm able to view here — that I'm not able to view at the bedside", while another noted that since the command center staff has easy access to patient data, handoffs are better and issues are less likely to be missed.

Assuming that these ICUs are not fundamentally different from ICUs in other facilities, the story highlights an issue that is endemic far beyond this particular set of hospitals: the frequent failure to bring data to the bedside in an effective way. This is ironic, as the big data and IT revolution brags -- incessantly, it sometimes seems -- about delivering data and analytics to the point where they can be most useful. That isn't consistent with the remarks from healthcare workers in this article.

Is caregiving versus patient monitoring an either-or proposition? I doubt it, as I've seen data-driven intensive care delivered reliably over long periods of time. Rather, I think the question is how to make data actionable through delivery to the right people without disrupting their workflow. It's a question for all clinical environments beyond the ICU. We need to make more effective use of routine clinical data.

(image source: Wikipedia)

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