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Defending patient safety

Johns Hopkins, Lockheed plan ICU modernization

Monday February 27, 2012
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Peter Pronovost
You can fill an ICU with modern technological marvels, but that doesn't mean the effect will be marvelous. In fact, it can be downright alarming.

"You can't find a working ICU right now," said Peter Pronovost, MD, PhD, senior vice president for patient safety and quality at Johns Hopkins Hospital, Baltimore, and director of the Hospital's Armstrong Institute for Patient Safety and Quality. "The monitors are stacked, none of them talk and they're kind of in this alarms race to see which can be the most annoying. It doesn't prioritize the most annoying isn't the most important. It wastes so much of nurses' time."

That's not only a waste of nurses' time, it's a patient safety issue that Hopkins and defense contractor Lockheed Martin hope to address in a project to modernize the ICU.


Photo courtesy of Johns Hopkins Hospital Working in the ICU, with multiple alarms and monitors, can be a burden for today's nurses, according to Johns Hopkins patient safety guru Peter Pronovost.
Integrating systems, enabling the 50 to 100 pieces of equipment in an ICU to talk to each other, is a top priority. Lockheed provides systems integration expertise, while Hopkins brings clinicians, researchers and systems engineers to identify needs, and to test and refine prototypes.

"Certainly you're never going to get better answers than going to the front line," said Rhonda Wyskiel, RN, BSN, a senior researcher at the Armstrong Institute . "The real goal of this is for me as a clinician to be able to provide the most efficient, safe care for my patient. "We're at a point in healthcare where we're pushing forward in technology in so many areas, in the ORs, and in the research labs, but on the front line we're still working with technology that doesn't speak to each other. Sometimes we revert back to paper to be able to get done what we need to do."

Technology, Wyskiel said, should be used to make the ICU more, not less, efficient.

"I'm a huge Apple fan, so I love the end-to-end integration of software and hardware," she explained. "To provide us with a system that has that kind of integration would increase my efficiency, I can't even tell you how much. So much of what we do is data entry for systems that don't talk to each other. If I get a patient from the ED in my unit, the ED is not all the same charting system or ordering system that we're on. Those systems never get to talk to each other. The patient needs a whole new set of orders in a new charting system. And that happens throughout the hospital."

That hospitals need to work with an integrator occurred to Pronovost on an airline flight when he realized that if United Airlines wanted a plane, it wouldn't buy components and try to build it. It would turn to an integrator. In a Journal of the American Medical Association article, and a Wall Street Journal interview, he said the healthcare industry needs a Boeing. It got a Lockheed.

"I got a call from Lockheed that said, 'We have the ability to do that. We're a big systems integrator and we want to be involved in that,'" Pronovost said. "I said, 'Fabulous. Let's try to make it happen.'"

Lockheed Martin calls the initiative ICE STORM, for Integrated Clinical Environments Systems; Training, Operations, Research and Methods. It includes ICU simulations and nurse training programs that blend virtual and hands-on practice.

"By using advanced simulation to model ICUs, we can investigate inefficient and ineffective clinical practices and create virtual prototypes to test improvements," Lockheed spokesman Christopher Williams said. "We expect to pioneer systematic improvements in many areas, including enhanced interconnectivity and interoperability of medical devices; faster, cheaper, more effective training methodology; more accurate tracking of integrated events; and smarter information delivery to the right person at the right time."

Hopkins is in the early stages of brainstorming and focus groups, with development of prototype systems to follow. High on the agenda is the problem of alarm fatigue.

"At any given time, my patient might have an IV pump beeping, their cardiac monitor beeping, a ventilator beeping," Wyskiel said. "I don't know which is the most urgent to go to first, but because of the sounds of the alarms I've developed a desensitivity so that I don't even hear all the alarms. So how can we decrease alarms?"

Pronovost pointed to the issue of angle of head elevation in hospital beds, which nurses manage by sight. "An engineer looks at that as a systems thinker and says, 'Hey, that system is archaic, devices for measuring angles are dirt cheap. They can be in any bed. Why aren't they in the bed?'"

The inefficiency of systems that don't communicate has "a huge impact on patient safety, it's a huge increase in cost and it's stressful and takes joy out of a nurse's work," Pronovost said. "There are a lot of opportunities to improve safety, reduce costs and make work more joyful."

John Grochowski is a member of the Nurse.com Nursing Spectrum editorial team.


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