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Cover Story: ER/ICU Management

escalated into a crisis or a serious problem.

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• A process improvement program that consistently ensured that best practices were implemented for ongoing enhancement of clinical outcomes.

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Once the tele-ICU program was in place, Ministry Saint Clare also found that it was much easier to recruit the intensivists and hospitalists who had previously been so hard to attract. The reason was the presence of the tele- ICU program promised a better qual- ity of life: no night or weekend calls, plus the assurance that these fragile patients were vigilantly monitored even when the bedside physician was not in the hospital. Clinically, the results of tele-ICU proved to be outstanding. As a new facility, the hospital did not have ex- isting data against which to compare improvement. However, when com- pared to industry standards, results consistently improved over time. In 2010, Ministry Saint Clare was below the APACHE predictive scores in the following criteria: • ICU mortality: 33 percent better than APACHE prediction;

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• Hospital mortality: 26 percent bet- ter than APACHE prediction; and

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• Ventilator days: 40 percent better than APACHE prediction. The tele-ICU program is also credited with maintaining a length of stay lower than expected for the patient population, thereby increas- ing throughput to allow the hospital to operate with maximum effi ciency. In 2010: • ICU length of stay was 37 percent better than APACHE predictions; and

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• Hospital length of stay was 41 percent better than APACHE pre- dictions. Clinically, the hospital achieved

near-perfect compliance with best- practice protocols to prevent gastric stress ulcers, blood clots and minimi- zation of time that patients spent on a ventilator. ICU complications were

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markedly reduced: • Zero ventilator-associated pneumo- nias since opening;

• Near-zero central-line catheter infections; and

• Extremely low rates of gastric stress ulcers and life-threatening blood clots.

The administration also identifi ed these additional positive ROI contribu- tions from the tele-ICU: • Program growth and new cases; • Variable savings from ICU days saved;

• Variable savings from hospital days saved;

• Improved documentation/CMI improvement;

• Improvements in nursing recruit- ment and retention;

• Daytime critical care recruiting and sustainability;

• Risk management/cost avoidance; • Reduced readmissions; • Increase in ICU capacity; and • Positioning for reform. Larry Hegland, M.D., has been chief medical offi cer at Ministry Saint Clare since the hospital opened. Prior to that, he spent his career in facilities where the ICU was managed in the traditional way – with private-practice physicians providing daily rounds and the ICU nurses managing the patient needs when the doctors were not present.

“Doctors really want to know that their patients are getting the best care. In our program, they can have a high-quality service to supplement the care they provide so that their patients are getting the optimal care, while the physicians can have a better quality of life,” Hegland says. “This model also helps to bring the nurses into the critical-care team model more effectively than what I see in other practice settings.” Julie Beeney, R.N., director of critical-care services, concurs. “The tele-ICU program has improved staff satisfaction and morale. Nurses know that at 2 o’clock in the morning, in- stead of paging a physician and waiting

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