The eICU: Integrating Technology

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The eICUIntegrating Technology Best
Practices in the ICUSteven A. Fuhrman,
M.D.eICU Medical Director
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Every system is perfectly designed to achieve the
results it achieves
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The Current State

• Inconsistent care processes
• Data availability
• Medical errors
• Capacity problems
• Clinical Staffing
• High costs
• Payors/patients demanding quality

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Staffing Intensivists Why?

• Reduced mortality
• Reduced complications
• Reduced length of stay
• Greater throughput
• Reduced costs

JAMA 2522023. 1984. Chest 96127. 1989. JAMA
2603446. 1988. JAMA 276322. 1996. AJRCCM
1571468. 1998. AnnSurg 229163.
1999. MayoClinProc 72391. 1997. CCM 27270.
1999. JAMA 2811310. 1999.
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Intensivists How?

• lt 6000 Intensivists in active practice
• lt 15 of ICUs with dedicated Intensivists
• lt 30 of ICUs have Intensivist available
• lt 25 of pts with Intensivist-directed care
• Projected national need of gt 30,000

COMPACCS Study. JAMA 284 2762, 2000.
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Obstacles to Care

• Adequate Staffing
• Problem recognition
• Physician identification
• Pager delays
• Data Communication
• Intervention follow-up

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Many Points for Delay
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Technology to Leverage Intensivists Turn
Reactive Care Proactive

• Telesurveillance/Teleconferencing
• Electronic Patient Record
• Real-time Vital Signs
• Continuous Data Analysis
• Decision Support

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The eICU Leveraging Critical Care Expertise
Medical Center
Community Hospital
Community Hospital
eICU
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eICU Operational Solution
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eICU
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The eICU Tools

• eCareManager
• The Source
• Smart Alerts
• Videoconference
• Xray Scanning
• Direct Hotlines

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Smart Alerts?

• Heart Rate Limit alarm is triggered as either
  high or low (H or L), with the patients set
  limit in brackets and the triggered alarm value
  following.
• Several criteria are used for determining if an
  alarm should be triggered
• Mandatory High and Low Limits Consecutive heart
  rate values gt 150 bpm or lt 40 bpm
• Patient-Specific Limits Timed median heart rate
  values crossing set upper or lower limits
• Default 60 130 bpm
• Coronary artery disease (at risk) 60 100 bpm
• Coronary artery disease (active) 55 75 bpm
• Custom 0 180 bpm
• Double clicking the alarm box (or selecting
  Patient Status from the tool bar) allows access
  to set patient limits.

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eICU Clinical Function

• Smart Alert directed
• Acuity/Lability driven R/Y/G
• Videoconference
• Telephone contact ICU/MD/other
• eMD Intervention empowered by data

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Delays Diminished
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Program Results

• LOS ICU Hospital
• Hospital Mortality
• Outlier Population
• Staff Satisfaction
• Financial Benefits

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ICU LOS Results
-11
-12
-3
-29
Severity-adjusted
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Hospital LOS Results
-7
-16
-9
8
Severity-adjusted
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SNGH ICU LOS
Project Life
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Outlier
Reduction
Drives
LOS
2
2
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Problem ICU Outliers
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Outliers Strain the System
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Hospital Mortality Results
-14
-8
-23
-26
Severity-adjusted
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eICU Program ResultsLives Saved

• 159 lives were saved during the Project
• 1 - 2 lives per year have been saved for each
  bed monitored

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Additional Benefits

• Improved RN satisfaction
• Leveraged MD night coverage
• Medical education
• Patient family satisfaction
• Facilitated ICU comparisons evolution of
  evidence-based practice

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Proarrhythmic effect of Aminophylline
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Conclusions

• The eICU model addresses commonly identified
  obstacles to idealized care in the ICU.
• The eICU model has resulted in marked outcome
  improvements as judged by common metrics of ICU
  performance.
• The eICU affords an opportunity to recognize
  differences in practice patterns thereby foster
  best practice care plans.
• The eICU offers ready availability of
  Intensivists for clinical monitoring,
  intervention, education.

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Thank you,