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12 Oct

Posted at 09:27h 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 most 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...

08 Aug

Posted at 15:20h in Blog

In medicine, every second counts. A patient can be stable one minute and crash during the next moment. Early detection, timeliness, and competency of clinical response are a triad of determinants that impact clinical outcomes of people with acute illness. Results from observational studies confirm that patients often show signs of clinical deterioration during the 24 hours before a severe event requiring clinical intervention.1  Timely detection of those subtle clinical warning signs has its own set of challenges. When those clinical values (especially vital signs) cross a critical threshold, they usually alert the bedside staff via beeping monitors. Because of the volume of alerts and the mountain of tasks that bedside staff manage, many alarms are simply silenced in seemingly stable patients. Thus, a critical value is often lost and not documented in the EMR system. Documentation of an alert is another task that can be triaged and forgotten. In some cases, especially in non-critical care settings, critical (outlier/severe) values may not trigger an alert, or the vital signs may not be taken as frequently.  Automated capture of vital signs and real-time alerts could reduce the burden on bedside staff while increasing data capture. However, the intense amount and frequency of data...

22 Jul

Posted at 16:27h in Blog

You may have heard of the term failure to rescue or the abbreviation FTR when discussing patient outcomes. Traditionally, FTR is defined as unexpected deterioration of a patient or death due to a complication. The complication could be due to an underlying illness or related to medical care. Both hospitals and physicians recognize FTR as an urgent problem with numerous and multifaceted contributing factors. A patient’s poor outcome due to FTR could be related to any of the following challenges:  Inadequate or inconsistent method of collecting vital signs data  Failure to recognize and respond rapidly to abnormal vital signs Delays in timely escalation of care for patients showing signs of clinical deterioration  Many hospitals manually collect vital signs, where data is entered by a health care professional into the patient's electronic health record (EHR) every 4 to 12 hours. This approach represents single data points in time but does not reflect what happens during time intervals between data captures. During these undocumented intervals, patients may rapidly or subtly deteriorate. By the time clinicians become aware of this decline, the complication may be full blown and lead to an FTR episode. How can a health care organization reduce the number of FTR cases? 1. Automate the Capture...

18 Jul

Posted at 10:24h in Blog

While preventing all medication complications is impossible, health care providers strive to identify the risks of complications for their patients.  Complications can increase a patient’s length of stay, consume limited staff resources, increase the need for higher levels of care, and even lead to the patient's death. When a patient unexpectedly deteriorates from a complication, the poor outcome is often referred to as a failure to rescue or FTR case. The term can be used as a diagnosis or as a safety and quality measure. Hospital records use a coding system that can identify the diagnosis for a patient, and FTR has such a code. Since 2003, many healthcare organizations review their records to identify the underlying causes of their FTR cases to improve patient care and outcomes. In 2010, the Centers for Medicare and Medicaid Services began to monitor FTR rates using an algorithm called Patient Safety Indicators 04 (PSI 04). With the advancement of the electronic medical record, data collection and analysis in the field of FTR has exploded. A few of the key studies and findings are highlighted below: Approximately 10% of general ward patients experience unexpected decompensation, with half transferred to an intensive care unit (ICU).1 Over 85% of cardiac...

31 May

Posted at 11:14h in Blog

Critical Care Medicine is the medical specialty of caring for patients with immediate life-threatening conditions. These types of patients need frequent assessment and have a greater need for technological support than other patients admitted to the hospital. Hence, the specialty involves the assessment and management of these critical patients in specialized units of the hospital. As with most of the medical specialties, critical care medicine has humble origins with the development of “Iron Lung” technology during the polio epidemic in the 1950s. In the earlier days of the specialty, any physician could render Critical Care. As this area of medicine became more sophisticated - involving advanced technologies and clinical skills, specialized nursing units in the 1960s called Intensive Care Units (ICUs) were developed to care for the critically ill patients. On the training side, formalized pathways to certification, in the knowledge base and skills to care for these patients, were developed through the American Association of Critical Care Nurses. Eventually, the established medical specialties of Internal Medicine, Surgery, Anesthesiology, Emergency Medicine, and Neurology created a formal training curriculum and certification in the subspecialty of Critical Care Medicine.  ICUs and Critical Care Medicine, along with Emergency Medicine, have become the safety net of...

27 May

Posted at 10:05h in Blog

HOUSTON, TX, May 8, 2022 – DECISIO announced yesterday the issuance of US Patent 11,309,079 B2, which related to a system, method, and computer program product for providing a patient dashboard system in a hospital setting.  The patent covers a method of displaying information in a patient care setting using a near real-time monitoring dashboard. It further covers the collection and aggregation of clinical information from multiple sources to interpret and display actionable insight. Patent 11,309,079 B2, titled, ‘System And Method For A Patient Dashboard’, filters, analyzes, and displays patient data that is relevant to the treatment of the patient, including recommended medical actions and pertinent positives and negatives results. The company recently rebranded DECISIO and launched a new website. The flagship product, previously DECISIOInsight, is now named InsightIQTM. InsightIQ reduces clinical variation with digitized bundles of care that prioritizes clinicians’ attention to at-risk, deteriorating patients for early intervention.  EnvisionIQTM, a clinical analytics platform, was announced in early 2022 and paves the way for a whole suite of DECISIO IQ products to be announced in the near future.  “The changes we have made at DECISIO over the course of the past several months only strengthens the confidence we have in the huge potential...

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...