Siemens SOMATOM Scope

ICU: Innovations are leading to better patient outcomes

December 17, 2015
by Lauren Dubinsky, Senior Reporter
A typical patient room in an intensive care unit (ICU) is filled with anywhere from 50 to 100 pieces of medical equipment that are manufactured by different companies and rarely communicate with each other. That’s becoming an issue now that health reform is demanding better outcomes and lower costs. The Johns Hopkins University School of Medicine announced plans in late October to redesign how medical devices in the ICU communicate. Companies will work to develop a health IT solution that gathers data from different monitoring equipment and identifies important trends that can help physicians prevent injuries and complications.

Johns Hopkins will provide the clinical expertise and Microsoft will provide technologies including its Azure cloud platform and services and software development expertise. Azure works by collecting and integrating data from different devices and providing critical analytics, computing, database, mobility, networking, storage and Web functions.

Microsoft will also help Johns Hopkins improve its Project Emerge, which aims to redesign the ICU workflow, culture and technology by bringing together clinicians, systems engineers, bioethicists, human factors specialists, patients and their families. The project revolves around a tablet application that coordinates and integrates all data from monitoring equipment and information systems.

The tablet app also includes a harms monitor that keeps track of hundreds of tasks for each patient and categorizes them into seven sections. It monitors which preventive tasks were performed and alerts ICU staff to situations when patients might be at risk. Johns Hopkins and Microsoft are planning on starting pilot projects in 2016.

Cerner Corporation has also done work to enable the devices in the ICU to communicate with its CareAware Critical Care solution, which automates the whole ICU including data from medical devices and patient records. It’s a vender-neutral technology that enables interoperability among medical devices, health care applications and EMR platforms and then aggregates the data so that it can be displayed in a single view.

In August, Cerner and Hospira announced an agreement to advance the integration of IV and EMR technology. Through the agreement, Hospira will connect its infusion pumps to the EMR at the point of care and add functionality for devices connecting to CareAware.

Remote ICU monitoring
It’s well-known in the industry that there is a shortage of staff in the ICU. In addition, critical care costs in the U.S. are as high as $80 billion to $100 billion per year and the demand for critical care services is growing more rapidly than the supply of these services, according to the Society of Critical Care Medicine.

Many hospitals including the Mayo Clinic and Saint Luke’s Health System in Missouri believe that electronic ICUs (eICUs) are the solution to the problem. Vital signs, medications, blood test results, X-rays and other data from bedside monitors are sent to a central workstation so the ICU staff can remotely monitor each patient. The staff can also monitor and speak to patients with high-quality cameras and audio monitors that are installed in the patients’ rooms. In addition, computer systems continuously analyze the data and alert staff if a patient is deteriorating.

A University of Massachusetts Medical School study investigated the impact that Philips Healthcare’s eICU Program had on almost 120,000 critical care patients across 56 ICUs, 32 hospitals and 19 health systems over the course of five years. The researchers found that 26 percent of the patients were more likely to survive in the ICU, they were discharged from the ICU 20 percent faster and 16 percent were more likely to survive hospitalization and be discharged.

Addressing ventilator issues
Ventilator induced lung injury (VILI) is a major problem in the ICU — 24 percent of all patients who are mechanically ventilated will develop VILI for reasons other than acute lung injury and acute respiratory distress syndrome. “Those ventilator-induced injuries are reportable and are a huge focus for customers to make sure they are on top of proper weaning, and managing the ventilating of their patients in the ICU,” says Kathy Forde, product manager of Life Care Solutions at GE Healthcare.

GE’s CARESCAPE R860 ventilator, which received FDA approval in July, was designed to address that issue. It’s equipped with lung protection tools that make sure that the different zones of the lung receive the treatment they need. With the CARESCAPE R860, clinicians can measure lung volume, possible lung recruitability, the capability of the lung alveoli to open and titrate the right pressure in the lungs after exhalation. Its breathing trial mode helps clinicians determine which patients don’t require further ventilation, as prolonged mechanical ventilation can cause complications.

Ventilators cause 50 percent of alarms and patient monitors cause the other 50 percent in the ICU, says Forde. GE has a tool on its central workstation that enables clinicians to print reports of the alarm traffic and manage the alarm settings by bed. “What you see is one or two patients are usually the offenders for alarms and their alarms may be set inappropriately or maybe they are appropriate and the patient is having a lot of arrhythmias,” says Forde.

As the elderly population in the U.S. grows, the strain on the ICU is also growing. “You think about the growing elderly population who are so frail and malnourished and that is a lot of the patients who end up in the ICU on a ventilator these days,” says Forde. About 40 to 50 percent of patients in the ICU are malnourished, according to a study in the New England Journal of Medicine. Traditionally, the dietitian tries to estimate a patient’s caloric needs or metabolic heart rate, which involves calibrating a cart, figuring out how to get it in line with the ventilator’s breathing circuit and waiting until the patient is in a steady state to measure.

The CARESCAPE R860 can measure the patient’s energy expenditure and tell the clinician exactly how many calories are required. It’s important to get the exact amount because if patients are overfed, they retain carbon dioxide and can’t be weaned off, and if they are underfed they lose muscle mass and are more prone to infection pressure sores. If patients get the calories needed they leave the ICU in a much healthier state. “The patient has a better outcome and financially we are saving millions of dollars for our facilities,” says Forde.

In 90 days, The Jewish Hospital — Mercy Health saved almost $9,000 per ICU patient by using the CARESCAPE R860 to track patients’ nutritional status. Since there was a 28 percent decrease in the amount of time the patients needed to be ventilated, the hospital estimated it will be able to save $5 million per year.

CT in the ICU?
If ICU patients need a CT exam, they will usually have to be transported to the radiology department, since many ICUs are not equipped with a CT. But now that a new CT that only requires 130.2 square feet of space is on the market that may change in the near future. Siemens Healthcare’s SOMATOM Scope CT received FDA approval in September 2014. To date, no hospitals have installed the CT in their ICUs, but Siemens believes that it’s something they should look into because of the staff coordination and patient safety benefits.

“It’s very dangerous to move a patient that is that ill because there are so many chances of things getting unhooked or wires or IVs coming loose,” says Karol Nguyen, product manager of the SOMATOM Scope CT. At least three staff members — a respiratory therapist, ICU nurse and patient transport personnel — need to work together to transport an ICU patient to the radiology department. Eliminating that would help hospitals cut costs.

“There is a cost associated with the staffing that is involved in the care supporting that patient, because the three staff that you are using for that hour to transport that patient could have been doing other things,” says Nguyen. “If something were to happen to that patient as they were being moved and their safety is compromised, there is a cost there, too.”

Treating with light
When caring for patients in the ICU, lighting may not be the first thing to come to mind, but research has shown that it plays an important role. Philips Healthcare’s HealWell health care lighting incorporates light into the treatment of critical care patients. “When you look in ICUs, the lighting is horrible. You have these really industrial lights and it’s more like a machine room than a hospital atmosphere,” says Carla Kriwet, CEO of patient care and monitoring solutions for Philips. “We are working on lighting, which is not just more comfortable, but also part of the treatment process.”

Lighting plays an important role if patients need to be calmed down due to fear or delirium, or if they need to be activated. The HealWell lighting system is automatically controlled based on algorithms that are linked to the patients’ monitors. The German Heart Institute in Berlin is currently piloting HealWell in its ICU. It’s helping to support natural sleep rhythms by mimicking the natural light patterns outside, and it also helps relieve stress.

HealWell is not yet available in the U.S., but many facilities in other parts of the world have it installed. The Altona Children’s Hospital, Asklepios Clinic and Berhmannsheil Buer Clinic, all of which are in Germany, and University Medical Center in the Netherlands are a few of those facilities. Now more than ever, hospitals are searching for solutions that help them achieve better outcomes and lower costs. Since one solution is not going to do the trick, the ICU has to be redesigned with that goal in mind. Ventilators that provide exact measurements, smaller CTs that can fit inside a closet and lighting that contributes to the healing process are all pieces of the puzzle.