UCHealth is a Colorado-based nonprofit healthcare organization comprised of 12 hospitals statewide.
PROBLEM
The organization has a new use case for virtual care, a program called Virtual Deterioration. Essentially, it’s trying to find patients who are in worsening condition in the hospital earlier for emergency and faster treatment to give them the best outcome.
“What we saw before this program was a lot of changes when we tried to detect deterioration, and then when we found it, we contacted the bedside caregivers. to see what happens next,” said Dr. Diana Breyer, chief medical officer. Northern Region officer at UCHealth.
“And so this is part of our plan to reduce that variability for patients who are on site so we can consistently monitor them with regular vital signs. more to make sure we actually saved them and use technology to keep an eye on them more,” she added.
PROPOSE
UCHealth has implemented the AvaSure carrier TeleSitter platform for patient safety and Provider Verification for the virtual ICU. It has extended the use of these technologies to Virtual Deterioration.
Prior to technology implementation, the virtual attenuation process involved staff at a remote clinical command center working in tandem with frontline staff.
“While there are great tech solutions to some of these problems now, the hardest part is managing change with your bedside team, the non-tech part.”
Dr. Diana Breyer, UCHealth
“And we tried a process before using the technology, which included a lot of secure conversations through our EHR, similar to texting, in addition to a lot of phone calls and no real the ability to visualize our patients,” says Amy Hassell, RN, senior director of the Center for Virtual Health at UCHealth.
She continued: “This approach has created a lot of friction and disruption for bedside staff who are trying to perform hands-on tasks with patients. “So we decided to offer an audio-visual connection. We have mobile carts and some of our hospitals have cameras in the ceiling so we can turn on that camera when something goes wrong. happening.”
With an in-room camera, doctors and nurses in the command center can now see and interact with patients and the care team.
“They could see what was going on so it was like we were in the room with that member of the care team,” explains Hassell. “When we do this, it helps us cut down on phone calls and bedside disruption, allowing us to stay engaged and do our part in the program.
She continued: “The program provides support and ensures to meet caregiving milestones during that impairment event and helps with triage if needed.
Since it is a clinical command center operating a variety of devices and platforms, staff have weekly operational meetings with the regional IT support team.
“They were part of our planning phases; moreover, we did our own IT technical dress rehearsals prior to deployment with clinical staff,” Hassell explains. every time we go live”. “IT’s been with us and has been very helpful in implementing this by helping support us, navigating us through difficulties as we push our boundaries. They are great partners for us. us and have been with us since day one.”
MARKET
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MEET CHALLENGES ONLY
Today, Virtual Deterioration technology is a separate platform. There will be a context-aware link soon, and that will be helpful because staff can then access it right from the patient’s graph through that portal.
Clinicians at the bedside use this technology. Nurses and paramedics are the ones who pull the tracking device into the room and use it at the bedside. In terms of reciprocity, it is the remote clinical command staff that is accessing that camera to join the team and interact with them.
UCHealth is developing a new role called “patient technology technician”.
“Once the patient is stable and they’re lying on the floor, the nurses will go see other patients they haven’t seen in a long time.”
Amy Hassell, RN, UCHealth
“Patient technologists are employees who bring mobile devices into the room so that nurses and doctors don’t have to be responsible for setting up the device and they can focus on the patient,” says Hassell. . “It worked. We’re really trying to get all of our employees operating under their licenses.
“This role will be very helpful as we continue to scale, so nursing staff are not the ones who have to carry around monitoring equipment to respond quickly,” she added.
RESULT
When UCHealth started looking at this project, it specifically looked for declines, such as the metrics being sought. Breyer notes that one of the well-established in the literature is around the reduction of coding events in the acute care setting.
“Those patients would ideally be taken to the ICU and if they’re going to code, code there or if they’re saved,” she said. “So we’ve seen an improvement throughout the work we’re doing around degradation in this space in both the northern and southern regions of UCHealth, where we’ve implemented the solution.” France.
“And that’s probably the biggest metric we can measure,” she continued. “I would add that in the space of degradation, it’s sometimes difficult to measure what you’re doing because you’re trying to show that you’re doing something that you haven’t done before. And measuring That omission can be a challenge.”
Another thing staff are measuring as a process metric is for patients who stayed on site and weren’t moved to a higher level of care by the time they had a rapid response event.
“We are measuring a consistent intervention after RRT that we didn’t have before,” says Breyer. “That’s another area we’re looking at. Ultimately, we’d like to see this improve mortality, but it’s a lagging indicator, and one that’s more variable over the course of the year. document how much of an impact they have on these recessionary events.”
Hassell emphasized that the institution will have to continue this trend and that the mortality indicator in the patient population is being affected.
“But we do have early data showing that our quick response rates go from 26% to about 86%, depending on where you’re looking as we do this across our system.” , she reported . “And then, in the initial data again, we saw code green events in our acute care areas drop by 25% to 70%.
She continued: “We’ve seen our blue code events drop, which helps us know we’re on the right track, we detect degradation earlier, thus reducing results. bad from code blue”.
In Breyer’s view, UCHealth has already gone through a post-surveillance phase, because that camera will be in place for six hours, and the virtual staff is helping to monitor and monitor that patient along with frontline staff who are working on it. very busy.
“And so we saw an increase in critical metrics after quick response anywhere from 39% up to 152% on ordered critical metrics,” Hassell explains. and then work on completing them.” “That’s a huge range that we’ve seen, but a lot of it because resources are tied up in that quick-response call.
“Once the patient is stable and they are on the floor, the nurses will go see other patients they haven’t seen in a long time,” she continued. “And so we have to make sure we take the time to monitor patients during that fragile period of time when they can still continue to deteriorate and need a higher level of care. That’s it. where we put a lot of focus and energy, and those were some of our early stats.”
TIPS FOR OTHER PEOPLE
What Hassell likes about the technology currently in use is that employees have been able to adapt it for another high-value use case.
“We’re still working on making it an innovation platform with the company, but I also think it’s instrumental and opens up avenues for us that we haven’t been able to before,” she said. idea. “We weren’t as successful as we are now until we introduced the camera product because it solved the problems we mentioned.
“And so, if you’re looking at any kind of hybrid approach, such as a clinical command center or nursing process, you want a great platform where you feel your staff seamless and easy to use and interact with,” she advises.
From a technology standpoint, it’s important to be easy and seamless for nightstands, says Breyer.
“While there are great tech solutions to some of these problems now, the hardest part is managing change with your support team, which is partly non-tech,” she concludes. . “And that’s where a lot of energy is required for a successful project.”
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