Spacelabs ICS Improves Decision Support at East Texas Medical Center Athens

New Technology Captures All the Tales of the Heart Upon admittance to the ICU of East Texas Medical Center (ETMC Athens) Athens, TX, Jane Doe was diagnosed with respiratory distress. After four days, she presented with a cardiac arrhythmia known as a trial fibrillation and flutter with a heart rate of more than 100 beats per minute. Her blood pressure started decreasing rapidly.

Using Spacelabs’ unique Full Disclosure application, which stores and analyzes patient monitoring data for a 72-hour period, cardiologists were able to go back in time and review her history to determine that her underlying rhythm was, in fact, normal. Given that, they decided to shock her heart to normalize the current arrhythmia. Without the availability of full-disclosure data, or had it shown an abnormal underlying rhythm, they would have pursued other interventions.

The immediate shock treatment minimized Jane’s risk of dislodging a clot that could result in a stroke or pulmonary embolism. Cardioversion was performed less than 30 minutes from the onset of atypical rhythm, and the patient had an excellent outcome

Can a software application change a life? Perhaps it did for Jane Doe. It also has significantly altered the day-to-day operations in the ICU and the entire cardiology department at the busy 117- bed ETMC Athens hospital. Intesys Clinical Suite (ICS) has enhanced clinical confidence, increased efficiency and empowered a higher standard of care, all while cutting costs.

ETMC Athens: A State-of-the-Art Hospital A state-of-the-art hospital, ETMC Athens offers uniquely advanced and comprehensive medical care in a small-town environment. It boasts such specialized departments and services as a full-time cardiac catheterization lab, cardiac stress testing and cardiac ultrasound, including echocardiography, with an outpatient cardiac and pulmonary rehab program. The emergency department has been repeatedly designated as a Level III trauma center with services that include not only ambulances, but also an Air 1 emergency helicopter. It also offers extensive diagnostic and laboratory services, as well as a fully equipped radiology department. With a mirroredglass exterior, four-acre lake, interior waterfalls and 32-foot atrium, even its setting and architecture stand out.

ETMC Athens is equipped with an 8- bed ICU typically staffed by 4 nurses, supported by a monitor technologist located at a central desk with access to all patient monitoring data. Patients leaving the ICU are often moved to the 12-bed Intermediate Care (Step Down) Unit, staffed by 3 nurses and monitored by one technologist at a central desk.

Capturing Trends in Heart Data As a hospital committed to high-quality cardiac patient care, ETMC Athens believes that high-quality patient monitors are extremely important. One year ago, the hospital was ready to update the technology in the ICU and selected Spacelabs because it had been extremely pleased with their performance in other areas of the hospital as well as at a group of 13 affiliated hospitals where Spacelabs’ monitors are also installed.

To keep on the cutting edge of patient care technology, when purchasing the new ICU devices, the hospital equipped both the ICU and the Intermediate Care Unit monitors with Spacelabs’ new, state-of-the-art Intesys Clinical Suite (ICS) applications. Full Disclosure is just one of a number of advanced components of Spacelabs’ innovative suite of software applications that add important new functionality to Spacelabs’ patient monitoring system. Currently, ICS is making a dramatic difference at ETMC Athens’s intensive care unit (ICU) and Intermediate Care Unit.

Asif Wahid, MD, ETMC Athens cardiologist explains that when it comes to understanding a patient’s full medical status, the heart speaks volumes. “By capturing a full 72-hour history of a patient’s monitoring data with Spacelabs’ advanced Full Disclosure feature, I can make better clinical decisions,” he says. “Full Disclosure allows me to see trends in patient heart rhythms and other vital signs, which enables adjustment in the patient’s plan of care when needed.”

With these advanced applications, ETMC Athens cardiology staff can actually turn back the clock to review previous data and use it to inform medical treatment decisions going forward.

An Advanced Software Suite Comprising eight advanced software components, ICS analyzes, stores and presents patient monitoring and related waveform data to caregivers located throughout the enterprise and beyond. With advanced network connectivity, ICS makes patient-monitoring information available wherever and whenever a caregiver needs it (inside or outside of the hospital), creating a vital signs surveillance system without walls. It is also capable of automating information flow to a full range of hospital information systems, enhancing speed and accuracy, while minimizing the risk of human error and data loss in copying or transcribing such data.

Other ICS Components Enhance Patient Care – Improve Staff Efficiency At ETMC Athens, clinicians are already taking advantage of many ICS components with plans to implement the entire suite in the future. In addition to examining patient retrospective data with Full Disclosure, cardiology staff is currently utilizing the Electronic Flowsheet component to automate collection of vital signs, eliminating time-consuming manual transcription. Using the Vital Signs Viewer, clinicians are seeing waveforms in near real-time on Web-enabled PCs throughout the hospital, at home and other locations. Using Print Manager, they are turning Spacelabs patient monitors into network printer-enabled devices, eliminating the management and cost of thermal strip paper. Together, the components enable caregivers to take full advantage of the large and important volume of data generated by patient monitors throughout the hospital.

ICS stores all patient data from all monitored areas in a centralized database accessible from any location running Vital Signs Viewer. As the hospital implements additional components, its goal is to have in the ICS database a universally accessible history of their patients’ data from the time they present until they are removed from patient monitors.

Spacelabs Delivers Immediate Benefits After installation, doctors, nurses and other clinicians enjoyed immediate benefits from ICS. “First and foremost, from a clinical standpoint, one of the major positive impacts of the system has been the availability of much more comprehensive patient data to drive the treatment decisionmaking process,” said Melissa Lehman, RN, nursing performance improvement coordinator for ETMC Athens. When the ICU relied on standard thermal strips, much of the data simply was not printed out or was lost in a mass of paper.

“Nurses on the unit are busy – they don’t have time to go through strips immediately after printing. Often it may be hours before the nurse can look to see what precipitated a patient event,” said Lehman. Now, they simply scroll back in time to examine the surrounding data right on the monitor. Viewing this information, they also can look for trends and watch subtle changes such as ST changes over time, which provides them with a significantly enhanced overall picture of the patient status.

Using an advanced, non-proprietary hardware and software architecture, historical patient information can be sent over the hospital network to other computers for remote viewing, providing benefits even before patients are brought to the ICU. DavidWilliams, RN, director of ICU nursing explains: “When new patients are being brought into the unit, we can access their historical data remotely before they arrive. As a result, we can be better equipped with the correct equipment, medication and other preparations. This has had a major positive impact.”

The system also facilitates more consultation among the patient care team. If monitor technologists have a question, they can share data with nurses. Nurses also have data at their fingertips to share with cardiologists. According to Williams, doctors are particularly pleased that they can go back in time and view a patient event firsthand.

Enhancing Cardiac Care Spacelabs’ ICS streamlines the entire cardiac care process itself, because prior to making rounds, doctors can look at monitoring data and then plan to see the most critical patients first, followed by patients scheduled for discharge. With more comprehensive data, clinicians also can be sure that patients have been arrhythmiafree for a certain period of time, sometimes leading to earlier discharges and improved hospital cash flow (since DRG reimbursement is fixed).

Automated Patient Charting Also significantly streamlining workflow at ETMC Athens is the ICS Electronic Flowsheet, which automates most of the time consuming and inexact tasks involved in manual patient charting.

The longitudinal patient flowsheets are viewable in intervals of the user’s choice, from one minute to one hour. The application allows complete customization of flowsheets and trend graphs and offers a pre-formatted endof- shift report.

According to Williams, the shift reports are a major benefit of this component. “Not only do these convenient and automated reports eliminate the chance of human error, but they also realize significant cost savings because on busy days, nurses typically have to go into overtime to sum up their patient data.” Williams estimates that each nurse saves about 30 minutes per shift that would otherwise be spent on charting. All patient data can be printed out directly from the patient monitors to any printer on the network, eliminating cumbersome thermal paper strips. The hospital staff agrees that the benefits of plain paper printing cannot be overemphasized. In addition to increasing clutter and inconvenience, thermal paper is expensive and time consuming to manage. Williams adds that the time and expense of creating reports with the strips, as well as storing and permanently archiving these reports through scanning or microfiching, also are significant and now have been eliminated by Spacelabs ICS.

Extending the Patient Monitoring System Beyond the Hospital’s Walls Enabling near real-time access to waveform data at ETMC Athens, Vital Signs Viewer is expanding communications to create a patient monitoring system without walls. The sophisticated application shares patient information in near real-time over any Web-enabled computer browser, providing access throughout the hospital, to doctors at home and at remote offices and hospitals.

With this enhanced access, physicians can implement more accurate and immediate patient management strategies even if they are not in the ICU. Nurses can monitor patients from any location – the nurse’s station, charting station or physicians’ offices. Staff also is pleased that the configurable display enables customization of parameters such as color, speed and size. A convenient pause feature freezes waveforms for study or hardcopy.

From an IT perspective, according to Steve Lowe, ETMC Athens Director of Engineering and Safety, “the system is elegantly designed and standards based, making implementation relatively straightforward and operation both flexible and reliable”. Key to this as well as to the ease of information access is the unique centralized database holding all patient monitoring and other waveform data hospital-wide. With this architecture, data can easily follow a patient through the facility. Competing systems typically utilize multiple databases for various locations, compromising speed and simplicity.

Advanced Monitoring Hardware Even without the benefits of the advanced software, clinicians believe the Spacelabs patient monitors offer unique benefits over the competition. Set-up for individual patients is so much easier than with the previous monitors. Busy nursing staff used to be required to spend up to 15 minutes to start up a device, while now this has been reduced to less than five minutes. When nurses are working bedside, they can access monitoring information for any patient in the system on their local monitor.

Moreover, they can rely on the innovative Alarm Watch feature to notify them of a patient emergency at any designated monitor location, enabling ETMC Athens’s busy and caring clinicians to be always in touch with every patient. In short, according to Williams, “The ICU nursing staff just loves the entire system. They feel really good about the enhanced patient care.” Cardiologists also are very enthusiastic about the system and feel that the more comprehensive information leads to a better standard of care and assists them in decision support.

A State-of-the-Art Vision of Cardiac Care What will the future bring? In keeping with its commitment to remaining in the forefront of technology, the hospital has a vision of patient monitoring data flowing throughout the hospital with secure but ready accessibility to every care provider who needs it. Doctors, wherever located, will be free to check on patients. Cross-enterprise consultations will be routine. When the hospital implements an interface to their ADT system, patient demographics and status information will flow from there to the Spacelabs monitors.

Changing the Paradigm of Care Part of this vision has already been achieved by the Spacelabs technology recently put in place, and sophisticated use of it simply needs to become routine. For example, with the remote access to historical patient data through Full Disclosure and to current patient information through Vital Signs Viewer, doctors are increasingly checking on patients remotely. Even today, if desired, physicians could plan virtual consultations across institutions and implement remote diagnoses for other hospitals without cardiologists on staff.

Currently, telemetry patients are being monitored remotely by a technologist at a central location. Soon the hospital will add Full Disclosure and Vital Signs Viewer to provide more comprehensive information and flexible information access to this department. Also shortly, with the addition of a new technology, the hospital will have the ability to forward patient data and alarms to existing wireless telephones and pagers, further expanding the reach of this vital information.

At ETMC Athens, cutting edge technology is and will remain an important part of its high standard of care and the hospital is confident that its current supplier (Spacelabs), in conjunction with its outstanding staff, will continue to keep ETMC Athens on the cutting edge of medical care.

©2006 MSP, Inc. Industry Alert Vol. 8 No. 1