SJH VISICU Project

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SJH VISICU Project

• A collaborative effort with VISICU and UW-Madison

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Agenda

• eICU Program Overview
• Implementation Plan
• Quality/Performance Improvement
• Future Direction

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Introduction

• VISICU was founded in 1998 and is the inventor of
  the eICU Program.
• Vision to create solutions that enable hospitals
  to save lives and improve patient outcomes
• VISICU first implemented the eICU program in June
  2000
• Implemented at St. Clares 2005

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The Hospital ICU Dilemma

• Rising ICU costs
• Shifting demographics in the aging population
• Practice variability within a hospital system
• Lack of accurate quality metrics
• Shortage of intensivists and critical care nurses
• Increasing concerns about patient quality and
  safety

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The Issue How to Redesign the System
If we want safer, higher-quality care, we will
need to have redesigned systems of care
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Adding People Is Not The Solution

• Nursing Shortages
• Aging ICU workforce
• Inexperienced young nurses and travelers in the
  ICU
• Recruitment and training costs increasing
• Intensivist Shortages
• Less than 6,000 intensivists in active practice
• 15,000 25,000 intensivists needed to staff all
  U.S. ICUs around-the-clock
• Lifestyle a major contributor to shortage
• COMPACCS Study, JAMA 20002842762

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The eICU Solution
A comprehensive ICU program

• A remote, centralized, intensivist-led care team
• Enabling technology for continuous monitoring
• Leverages intensivist and critical care nurse
  talent
• Engages clinicians in the redesign and management
  of ICU
• Standardizes ICU practices

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eICU Program

• People
• 24 x 7 Intensivist led multi-professional care
  team
• Process
• Evidence based standards
• Technology
• eCareManagerTM System
• Continuous Improvement
• Tracking Benchmarking
• On-going Feedback
• Clinical Transformation
• Clinical Optimization

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VISICU
VISICU
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eICU Program A New Model of Care
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Element 1 - Bedside Providers

• Attending physicians surgeons who know the
  patient and their hospital
• Well Rested
• In Charge
• Decisions reliably implemented
• ICU RN with time to evaluate provide direct
  care
• Assisted with information and communication tools
• Provided immediate support and access to physician

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Element 2 Intensivists
How Intensivists Improve Care

• Physician Presence
• Facilitate communication and coordination
• Balance demands
• Expedite care
• Reduce points of failure and delay
• Focus on critical care patients
• Responsibility for quality initiatives

Real-time Data
Clinical Action

• Reducing the interval from the time data is
  available until the time it is used for
  decision-making drives significant and often
  unexpected improvements in care. - Gary Yates,
  M.D., VP of Quality, Sentara Healthcare

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Element 3 - The eICU Program

• Additional intensivists critical care nurses
  24/7
• Awake alert
• Immediately available
• Fewer Emergencies
• Time to help
• Virtual presence at any bed at any time
• Computer assistance
• Regular, repeatable tasks
• Continuous data analysis
• Communication documentation
• Immediate assistance
• Best practice facilitation
• People tools support best practice
  implementation

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Understanding the Partnership

• Bedside Clinicians
• Set the multi-professional care plan
• Manage minute to minute care
• Identify new problems intervene
• Respond to crises

• Remote Clinicians
• Ensure diligent execution of care plan
• Identify new problems intervene
• Track consistent use of accepted best practices
• Provide mentoring
• Prioritize activities and provide support during
  multiple crises

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Virtual Presence
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Population Management Data Synthesis
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Multi-Professional Coordination
Documentation for
Nursing
Respiratory Therapy
Notes
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Application Interfaces

• Inbound to eCare Manager
• ADT/LastWord
• Vital Signs/Bed Side Monitors
• Lab Results
• Medications
• RN Documentation
• Outbound from eCare Manager
• VISICU Notes to CMR

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Evidenced Based eCare
Daily Management
Care Planning Coordination
The Source - Decision Support
Measuring Performance
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Evidenced Based eCare
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Smart Alert Prompts

• Potassium
• Hemoglobin
• Acid Base
• Urine Output
• CrCl
• DVT Prophylaxis
• End of Life
• Sepsis

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Multi-Professional Coordination
Care Plan Task List Facilitates communication
between bedside and eICU team and provides data
for many reports
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Measuring Performance
Benchmark
eSearch
Core
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Components of Critical Care Transformation
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Critical Care Transformation
Health System Improved Clinical and Economic
Outcomes Market Share Growth
Improved Clinical Outcomes Staff Satisfaction
and Retention
Critical Care Leadership Leverage
Personnel Quality Measurement
Right Care, Right Now Standardized Care Quality
Assurance
eICU Program Intensivist-led Care
ICUs Goal-directed care
Bundles Tracked Implemented Integrated Care Team
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ImplementationPlan
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VISICU Implementation Team

• Project Sponsor Dr. Michael Kryda
• Business Manager Kathryn Olson
• IT Partner Mike Fowler
• PMO Partner Michael Balda
• VISICU Steering Team
• Joe Lewis
• Joe Wagner
• Judy Larson
• Jackie Pfeifer
• Todd Zieglmeier
• Elaine Weber-Spatz

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Time Line

• Phase I - August 2008
• UW Hospital TLC 24 beds
• St. Josephs Hospital MICU/CCU 16 beds
• Phase 2 Second Quarter 2009
• UW Hospital Cardiology ICU 7 beds
• St. Josephs Hospital SICU 26 beds

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Quality Performance Improvement
Breslow CCM 2004 3231-38
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Quality Performance Improvement

• Decrease in mortality rates
• Decrease in length of stay in the ICU and overall
  hospital length of stay
• Avoidance of complications
• APACHE III/IV methodology utilized with
  comparative data on mortality and length of stay
• Compliance with regulatory requirements
• Bedside real time continuous quality improvement

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Benchmark Reports

• Processes

Outcomes

• DVT prophylaxis
• Stress ulcer prophylaxis
• Beta-blocker usage
• Low tidal volume ventilation
• Transfusion Threshold
• Glycemic control

• Severity-adjusted mortality
• Severity-adjusted LOS
• Low risk monitor patients
• Ventilator days

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APACHE Methodology

• Acute Physiology, Age Chronic Health
  Evaluation
• Severity-adjustment methodology that predicts
  outcomes for adult critically ill patients
• 27 variables collected for each patient
• Patient data used to formulate individual
  predictive equations
• Predictions regarding mortality, LOS and need for
  active treatment are generated
• .

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Recruiting/Retention Advantages

• Physicians and Nursing
• No change in physicians or nurses needed for
  bedside care
• Physicians determine level of support they desire
  from E-ICU physicians
• 24/7 another set of clinicians available for
  questions and/or consultation
• Improved life style for local physicians
• Continuing education for clinicians

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• Questions?