patient safety quality healthcare

March/April 2010

TRENDS

Sentara Supports Its Commitment to High Quality Care and Patient Safety with Biomedical Device Integration

Sentara is a national leader in patient safety and quality care innovation, operating in over 100 care sites in Virginia and North Carolina. Sentara is one of the most progressive and integrated healthcare organizations in the nation with a culture of safety focused on error and injury reduction through simplified rules of behavior for everyone working in the environment of care. We are also committed to using technology to improve patient safety, such as the Sentara eCare® Health Network, a robust electronic health information system with built-in safety measures to prevent medical errors. We were the first in the nation to pioneer and develop the eICU® using Visicu®, a remote monitoring system for intensive care.

Sentara is always looking for technologies to improve patient care and safety. As we started our initiative to implement our electronic medical records system, we started looking at ways to improve patient safety and nursing efficiency in our acute areas and other clinical departments that chart frequent vital signs. We identified biomedical device integration (BMDI) as a technology that would meet our objectives because we knew it would free nurses from the tedious, time-consuming task of manually transcribing patient vital signs data and keying it into the EHR. It is no secret that documentation takes time away from direct patient care. In fact, a recent Time and Motion Study (Hendrich et al., 2008) found that nurses spend over 35% of their time on documentation. More important, while manual charting obviously takes away from patient care and surveillance, time isn’t the only issue. Evidence continues to suggest that inadequate observation and surveillance can lead to poor patient outcomes such as failure to rescue and mortality (Aiken et al., 2002). Device integration, therefore, became a patient safety and care priority for Sentara. We had our Epic information system in place and ready to accept the data, and we hoped that integrating data into the system would be straightforward.

The challenge was to find a device integration solution that would work in multiple areas of the hospital, wouldn’t introduce multiple points of integration, and that would connect all of these devices, not just monitors. We realized that the solutions offered by our monitoring vendors would be too limiting, and we didn’t have the budget to buy all new devices for each area to make that integration happen, especially given the number of areas we needed to integrate. We also realized that these solutions would introduce multiple points of integration, and we wouldn’t be able to get all the data from devices that are connected through our monitors, such as ventilators.

We decided the best approach was going to be a vendor-neutral solution that allowed us to connect all the devices we needed right away, add devices as needed, and ensured that all data from all connected devices, including vitals signs and device data, would integrate with our Epic Information System. We chose Capsule Tech, Inc., based in Andover, Massachusetts, to integrate our ventilators, fetal monitors and select physiological monitors because they have a proven solution with over 450 devices available for connection using their DataCaptor™ software. This approach didn’t tie us to a specific medical device vendor and its product line and gave us more data points and more integrated devices than other solutions.

We needed to integrate a total of 794 medical devices including Philips physiological monitors, Hamilton Galileo vents, Puritan Bennett 840 vents, AS/3 and S/5 monitors, various types of GE monitors, and the Corometrics fetal monitor for 588 beds in the adult and neonatal ICUs, labor and delivery, PACU, ambulatory surgery centers, and endoscopy. The implementation itself went very smoothly and was basically considered a non-event. We have had no unscheduled downtime of DataCaptor since our implementation 2 years ago. I attribute this success to planning—to identifying who needs to be involved, setting expectations early, and thorough testing, as well as proactive controls and monitoring. We also couldn’t have done it without active participation from clinical engineering; they were key to our success because they are the ones who really understand the medical devices and their capabilities and restrictions.

The BMDI project did more for Sentara than simply provide connectivity—it improved clinical workflow and satisfaction and allowed clinical staff members to focus more of their time on patient care. In fact, I decided to measure the time saved and estimated that our nursing staff saves about 8 minutes per hour per patient through automated documentation. Even more impressive, if you multiply that 8 minutes over a 24-hour period, the time savings accounts for as much as 192 minutes, or 3.2 hours per day, per patient. This means that in one year we are able to give back over 1,168 nursing hours per year, per patient stay, to our nursing staff. This has obviously more than exceeded our expectations. And while this time savings is significant, the objective here was not to cut down on nursing hours or to eliminate nursing positions, but to realize that we can give those nursing hours back to the clinical staff so that they can do their real job, which is to take good care of their patients. We are so thrilled to be able to give that time back to them.

Our BMDI implementation has also helped with our overall patient safety objectives. Now that we are moving toward data mining and informatics, it is imperative that data entry areas are eliminated to provide quality in our system. This is the byproduct of the BMDI savings; elimination of data entry equates to more time with the patient, less errors, and improved patient safety. And our clinical staff agrees. Kathy McCoy, RN, BSN and ICU manager reports, “BMDI has allowed our nurses to spend more quality time with patients. Transcribing vital signs from the monitor took, on average, up to 1 hour during a 12-hour shift. Transcribing vital signs was very task oriented and did not directly add to the patient’s care. Now that the vital signs enter the chart passively, the nurse quickly reviews the results to ensure accuracy and files the results.” David Grooms, our Respiratory Clinical Program Manager, concurs, “BMDI has revolutionized our approach to taking care of mechanical ventilator patients. It allows bedside practitioners to more rapidly and efficiently synthesize data, which has contributed to faster response times in events of clinical deterioration, increased understanding of physiologic changes, and improved communication patterns among multiple personnel involved in the care of the patient.”

The challenge we now face is that every department and facility wants BMDI because they see how much it improves patient care and safety. My team is therefore trying to manage how to get this done, especially given all the other projects we are working on. I’m not complaining though, this is a good problem to have. I am truly proud of how successful our BMDI implementation has been and even more proud to be working for an organization that is committed to patient care and safety and that uses innovative technologies to make those initiatives a reality.

Raphael Aquino was the technical manager of biomedical device integration for Sentara eCare Health Network and has recently accepted the Integration Manager position for Sentara IT. Aquino received his master of science degree in management of information technology from the University of Virginia (McIntire). He has more than 10 years of IT experience with a wide range of practice from software and web development to project management and consulting.

For more information and details on Sentara’s Implementation (including the project scope, planning, implementation process, design architecture, lessons learned, suggestions for training, and more) listen to Raphael Aquino’s webinar at http://capsuletech.com/medical-device-applications-webinars.htm.

References
Hendrich, A., Chow, M., Skierczynski, B., & Zhenqiang, L. (2008). A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal 12(3), 25-34.

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002, October 23). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 288(16), 1987–1993.

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