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11 Feb

Posted at 17:34h in News

How Digitizing Protocols, Care Pathways, and Best Practices Helps Clinicians Save Lives. One-third of hospitalized sepsis patients die, according to research published in 2017 in JAMA: The Journal of the American Medical Association. Yet there’s recent research that suggests use of early goal-directed therapy, or EGDT, in the emergency department care of patients with severe sepsis and septic shock can save lives.[1] But translating research knowledge and patient information into clinical practice pathways can be complex, time-consuming and resource-exhausting, especially in hospitals already facing challenges that can lead to variation in care at the department level or even throughout the enterprise. Not surprisingly, those challenges can lead to significant consequences for the patient experience and outcomes, including incidence of sepsis, readmission, length of stay and more. This is where digitizing hospital-proven care pathways may hold the power to help beat the odds. “Applying digital capabilities can give the clinician a flashlight for peering into tons of data, which could reveal potentially life-saving insights,” explained Vivek Bhatt, chief technology officer, GE Healthcare Clinical Care Solutions. “Without visibility, how can a clinician begin to see the whole picture?” Digitizing may lead to more compliant care, which translates into improved patient outcomes, including lives saved. A 10% increase in compliance to...

08 May

Posted at 19:37h in Blog

Patient and family-centered care (PFCC) has become an integral component of modern medicine. It is widely adopted in outpatient care settings, where it is improving the quality and efficiency of care while increasing patient and provider satisfaction. Additionally, CMS payment models, such as MACRA, are furthering adoption by tying physician payment to patient and caregiver experience and patient-reported outcomes. But how has PFCC fared in the intensive care unit (ICU)? In the ICU, emotions are heightened, decision making is rapid, family member involvement is high, and the risk of death is always looming. These challenges have contributed to slower adoption of PFCC in the ICU. Healthcare providers have traditionally been viewed as a risk-averse group with slow cultural transformation and resistance to workflow changes – particularly those directly affect care delivery. However, these behavior patterns are changing – even in the ICU. Shifting the paradigm More and more ICUs are now embracing PFCC. Traditional ICU environments are increasingly viewed as outdated and obstructive. It wasn’t that long ago that visitation periods only occurred twice daily, and physicians could round on a patient for days without ever meeting a family member. Status updates were shared with families only by nurses who had to piece...

05 Apr

Posted at 19:41h in Blog

Today, Rapid Response Teams (RRTs) are a crucial component of many hospitals.  Implementing a RRT was one of the six strategies that defined the Institute for Healthcare Improvement (IHI) 100,000 Lives campaign.  Most RRTs consist of critical care nurses, but they can also include respiratory therapists, pharmacists, and physicians. Research consistently shows that patients exhibit signs and symptoms of deterioration for several hours prior to a code.  These symptoms include changes in vital signs, mental status, and lab markers. The goal of a RRT is to intervene upstream from a potential code.  They reach the patient before deterioration turns into crisis.  This is different than a code blue team that typically responds to a patient that has already decompensated to cardiac arrest. Historically, most hospitals relied on busy bedside nurses to identify crashing patients and call for rapid response.  With 49 states having no limits on the number of patients assigned per nurse, many medical-surgical ward nurses are caring for 6 or more patients per shift.  Placing this additional responsibility on their already over-flowing plate is challenging at best.  Providing a RRT empowers bedside nurses to trigger an escalation of care earlier and faster.  Measurable Improvement in Patient Outcomes Hospitals using RRTs typically observe...

09 Aug

Posted at 19:51h in Blog

Unfortunately, we see the following scenario play out all too often:  A family brings an elderly loved one to the hospital for what was intended to be a simple procedure.  While hospitalized, she develops a urinary tract hospital-acquired condition (HAC) from foley catheter complications.  The family was prepared for a simple stay, and instead they are faced with a prolonged hospitalization with risks of bacteremia and sepsis. A colleague once wrote that she sees HACs like an eccentric family member with a habit of showing up unannounced, luggage in tow. He brings suitcases full of complications and leaves a trail of havoc in his wake.   Simply stated, this pesky relative created a potentially avoidable disruption - he could have simply called ahead!  In the same vein, HACs are avoidable complications that occur while a patient is hospitalized for an unrelated condition.   Trends in HACs In 2014, the CDC estimated that on any given day, 1 in 25 hospitalized patients would develop at least one infectious HAC.  Despite this seemingly high statistic, HACs are decreasing.  Between 2008 and 2014, we have seen: ·      A 50% decrease in central line-associated bloodstream infection ·      A 17% decrease in surgical site infection after abdominal hysterectomy ·      A 13% decrease...

26 Jul

Posted at 20:13h in Blog

Visual reaction time is the time required to respond to visual stimuli. Scientists have studied visual reaction time for many years, particularly in response to color stimuli. These studies consistently demonstrate a faster reaction time to green and red - as compared to yellow.  This is not surprising, given our environmental conditioning to traffic lights, brake lights, technology warning indicator systems…etc. But, let’s focus on red.  Red is undoubtedly the most psychologically influential color.  What other color can cause a person to slam their car brakes so forcefully that the $7 triple, venti, soy, no-foam, 2-pump-vanilla gem held lovingly in their hands splatters to its premature death in a blink? Behold the power of red.  This manipulative color’s ability to influence behavior can be traced back to our primate ancestors.  Primates, unlike most mammals, have retinas that can differentiate between red and green. This trait presumably evolved to better identify edible fruits – which are typically red in color.  But the ability of primates to differentiate color is profoundly more complex than helping them find fruit.  The evolution of this trait afforded our primate ancestors, such as the Mandrill monkeys, rapid visual reaction time to color as an indicator of dominance.   Vibrant...

28 Jun

Posted at 20:17h in Blog

Stay focused.  Stay fearless. Stay strong. Oh, and don’t fall 4,000 feet…  These thoughts mercilessly taunted me as I peered up at my colossal opponent.  A first-year medical student at the time, I didn’t yet see the parallels between my new-found hobby, traditional (“trad”) rock climbing, and the practice of medicine.  Both scenarios require two things:  a healthy resilience to fear and an ability to tune out “noise.”  Looking back, now, scaling Cannon Mountain was a metaphor for what life as a resident had in store for me:  shaky call nights spent battling fear, distraction, and exhaustion. Focus and confidence were crucial to guiding patients through unpredictable and often perilous conditions.  These hospital shifts had their fair share of cruxes each lined with potential “epic” failure, and like rock climbing, there was no room for error. Today, before they even reach for their ropes, cams and nuts, physicians have intel to map the best course for the climb.  However, this information isn’t without cost.  It is accompanied by significantly more noise.  I remember a particularly challenging climb, complete with dime sized ledges and less-than-ideal cracks and finger pockets, that I on-sighted with a good friend of mine.  As the lead, it took...