Extending the Care Team Through Technology
Walking into Nemours Children’s Health System’s Clinical Logistics Center feels somewhat like entering an air-traffic control center, or even a military command unit. A brightly lit wall of video monitors, operating 24/7, beams multiple images and an ever-changing stream of numerical data, while the white-uniformed staff closely tracks every screen, working in intense four-hour shifts.
For more than five years, our team of paramedics and emergency nurses has closely monitored the vital signs of more than 200 patients each day in our hospitals—Nemours Children’s Hospital in Orlando, as well as Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., nearly 1,000 miles away.
Every patient’s vital signs and electronic health records are linked to the center, where information on the screens is labeled green, yellow, or red to clearly indicate whether a patient is stable, declining, or needs immediate attention. The Clinical Logistics Center staff, closely tracking 20 to 30 patients each, are electronically linked to every patient room in our hospitals and can instantaneously alert the nursing staff, initiate a rapid-response team, or even tap into a high-resolution audio/video connection, available in every room, to provide virtual care.
Combatting Alarm Fatigue
I am a pediatric critical-care physician by training, meaning alarms are my business. Research shows an almost linear relationship between medical errors and the number of tasks assigned to a bedside provider. In hospitals across the country, on average, a patient alarm is sounded for clinicians every 92 seconds.
To counteract this unwavering demand and closely track patients to preemptively identify downturns in their condition, Nemours Children’s Health System built the Clinical Logistics Center into our model of inpatient care. The model was designed to reduce systemic redundancies and ensure fail-safe responses. We can’t perform miracles, but in five years, we have had no unexpected deaths on the pediatric floors, largely because no alarms go unanswered for more than 90 seconds and no patient can suffer a severe downturn without staff quickly being alerted so they can immediately move the patient to the ICU.
While we started the Clinical Logistics Center to eliminate delays in providing critical care, we have been able to innovate and explore new ways to deploy the center for critical decision- support and for coordination of bundled tasks. A prime example is a recent initiative we launched to develop protocols to significantly improve our response to sepsis.
Early and accurate recognition of pediatric sepsis is challenging because many children do not show obvious signs of septic shock. Our sepsis response tool, in use since November 2016, improves the identification of and response time to this deadly infection. Since then, we’ve had considerable success: a 35 percent improvement in sepsis response time and dramatically reduced frequency of pediatric sepsis, from 2 percent to 0.05 percent.
Initially, some of our staff were uncomfortable with the idea that someone would be electronically looking over their shoulder. But they realized pretty quickly that the center is a valuable form of decision support. Staff members appreciate the advantage of having a second set of eyes helping clinicians achieve optimal performance in every aspect of patient care.
We see growing potential for broader, deeper applications. We envision extending the system to serve other affiliated community hospitals. We also see the possibilities of employing audio-video links so that our specialists can see and talk to their patients remotely at any hour of the night.
Our system is still a work in progress, but we see remarkable promise for enhancing care and, ultimately, saving lives. For any health system that might consider this option, it’s not as complicated as it might appear. In my view, if just a single catastrophic event is prevented, the system has already paid for itself.
This is not just about watching and listening for alarms. It’s about setting up a smart support system and incorporating that extra backup as part of the culture. For our clinical staff, it is making their lives easier. And for patients and families, knowing that a team is monitoring their care 24/7 is a real reassurance.
Stephen Lawless, MD, MBA, is senior vice president and chief clinical officer, Nemours Children’s Health System, Wilmington, Del.
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