Wednesday, September 7, 2016

The ICU and How to Deal with the Tsunami of Information

Walk into the intensive care unit in just about any American hospital, and you’ll be bombarded with beeping and blaring noises and flashing lights. It may look high tech. It’s not.

In fact it is not. The modern ICU is still functioning in the ear of the 1960s.  It’s “no different than it was 50 years ago,” said Dr. Peter Pronovost, a critical care physician at Johns Hopkins Hospital in Baltimore. “There are stacks and stacks of machines with wires sticking out of them. It’s chaos.”

ICUs are one of the most crucial departments of any hospital — heroic places with devoted staff who pull the sickest of patients from death. But many ICU physicians say they’re also woefully — and often dangerously — out of date. Six million patients in the United States pass through ICUs each year, and studies show serious and sometimes fatal medical errors are routine. And a recent reviewpublished in the journal Critical Care found no major advances in ICU care since the field’s inception in the 1960s.
Now, a handful of doctors and nurses in places like Baltimore, Boston, and San Francisco are trying to yank the ICU into the 21st century.
In addition to the side effects of beeping monitors, ventilators and other critical life support systems there is the aspect of the patient experience.
For many patients, time spent in an intensive care unit is a deeply disturbing experience, and not just because they are suffering from a serious illness. They are often heavily sedated, encircled by beeping equipment, unable to talk or even think clearly. Doctors and nurses prod their bodies as scores of trainees watch.
“I could feel people touching me but I couldn’t move,’’ said Ashleigh Robert, 30, who spent three weeks in the ICU at Beth Israel Deaconess Medical Center in Boston awaiting a liver transplant. “It was extremely frightening.”
It is even overwhelming to normal healthy visitors. The environment is foreign, sterile and stripped of humaness,  without decoration or art. It is inhumane.
Medical advances such as heart pumps and ventilators have led to more ICU survivors. About 80 percent of the 5 million patients who end up in intensive care each year return home. But there is a growing realization that many are left emotionally troubled by the experience, which can be marred by hallucinations, poor communication, lack of respect for privacy, and, later, post-traumatic stress syndrome.
New technology may also help ICUs — once notorious for alienating families and keeping them at arm’s length — better include loved ones in a patient’s care.
UCSF is now testing bedside tablets that patients or families can use to upload photos and descriptions of themselves. They can let doctors know what they like to be called, what their hobbies are, what they fear about their hospital stay, and what their healing goals are. The care team can then see them as individuals — and not, Schell-Chaple said, as just some 48-year-old man in Bed 8 who had a liver transplant.

“The ICU environment,” she said, “is not set up to treat people with respect and dignity.” Now, a group of leading hospitals, including Beth Israel Deaconess, is working to make the ICU less terrifying and more humane, using innovative tools such as iPad applications that feature patient biographies and journals kept by nurses.

Solutions such as AWARE and EMERGE have been developed to cope and assimilate important information into a coherent structure.


Enhanced Communications
  •  Multiple  organ systems displayed at once
  • Less time spent looking for information  across different systems
  • Communication  dashboard – whiteboard,  goals of care, tasks, etc.
  • Better communication  with patient and family members
Reduced Overall Care Needs
  • Lower utilization of central lines
  • Fewer unplanned surgeries
  • Fewer radiology tests
  • Fewer transfusions


Patient-centered Care
  • Patient data organized by organs and systems
  • Multiple  organ system monitoring
  • Task list that is implemented & updated
  • Best practices checklist at the Point of Care
Promote Timely Delivery of Evidence-Based Interventions
  • Smart alerts provide clinicians relevant information for potential patient care needs
  • Task oriented viewers include ICU checklists and timelines
Performance Metrics
  • Quality improvement metrics
  • Comprehensive reporting
  • Reporting infrastructure for external compliance with quality indicators
The dashboards display sets of data grouped by individuals in a readily available user friendly display.

Project Emerge | Johns Hopkins Armstrong Institute

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