Monday, August 31, 2009

Clinical Transformation

I love the new commercial. The daughter asks the parents a simple question and they begin to rattle off information containing the word within the request. Notice that they never get her the right information to answer her question.

The internet has made us more connected, and more informed than ever before. We are masters and weeding quickly through information, and scanning documents to find the nugget that we need, but how do we know we are getting the right information? How do we assess the nugget is not just information containing the word but not really providing the answer? Apply that thought process to the speed at which information travels to our clinicians. How do we make sure the right nugget of information gets to their hands at the right moment? How do we delineate critical vs clutter?Stay Tuned for the next post as we continue the discussion.

Clinical Transformation is an evaluation of the information, process, people, and technology. It provides a solution for how these items interact. It’s focused on the distinct goal to increase value. It does not simply use the processes to monetarily create value but also by value through improving quality of care delivery. Removing the Clutter from the caregiver and providing them with the right Data, at the right time, and in the right format. Patients need access to caregivers and vice versa. Caregivers need access to patient’s information.

ECRI Institute ( ) pointed out in their paper about the Top 10 Technologies for the “C-Suite” to watch in 2009, that Alarm Automation Tools will be an important hospital tool. However, they encourage hospitals to consider the following questions:

« Which patients are assigned to which nurses at any given time?
« Which devices are assigned to which patients at any given time?
« What data will be transmitted?
« Which patients’ alarms should be sent to which nurses?
« Which alarm escalation model will be employed?

We add this question, once you start automating your alarms how is your response to the need categorized? Do you have a response plan based on the categorization or on the specific alarm?

Sphere3 offers a number of solutions to how to effectively categorize alerts to have more effective alarm response.

Saturday, August 22, 2009

Alarm Overload

If your hospital is considering using the wireless device to receive clinical alarms direct to caregivers to “make them more efficient” consider this:

  • Automating the Nurse Call System on average can send 5 alarms (not considering escalation which could double this potential) per patient
  • Automating the Telemetry on average can send 15+ alarms per patient
  • Automating the Vents and Pumps without Data (ie through a contact closure – not the full information available) can provide 2 alarms per patient
  • Automating the Bed Exit Alarm is a single alarm per patient

Automating the additional Bed Alarms can send up to 28 alerts per patientThis does not include things like Bed Management, Lab Results, Orders, Automated Process Stations, etc. The question is balance. If you were to automate all of these alarms you could be sending over 51 alarms to your caregivers per patient. In a 1:4 Ratio situation that’s over 200 alarms! Planning and preparing for these are crucial. Categorizing alarms and keeping response procedures simple can improve the process of automation. At Sphere3 we specialize in evaluating the current situation and providing best practices solutions. Understanding the information that is being processed, the systems that are sending the data, and the caregivers workflow is our specialty. Many providers will encourage automation as a decision point for their product, but understanding the full scope of the integration is the key.

Contact us for more information


I just enjoyed the X3 Summit in San Fransico. The learning and collaboration was great, and I look forward to engaging more with my new colleagues. From now on when you read the blog we will work in groups of 3 - this will keep the blogs concise and the information structured in a optimal learning paradigm - the power of 3.

Social Media
Having the conversation - is intimidating to say the least. Presenting your learning in a manner which readers can engage and interact with the findings puts the presenter in danger of "being wrong". I would object - that the conversation should not be able being wrong, especially when we are looking at healthcare. It must be about finding the best solution to our ever growing need. Having the conversation is about engagin new ideas, challenging the thinking of the norm, and establishing whether status quo is most effective or needs to be adjusted. In a world of Twitter, Facebook, and Blogs our thoughts are moved freely our abilities to assess are only limited by our abilities to tolerate the conversation. Long-Term -- Healthcare can be improved by these conversations but we must be prepared to move thoughts and words into action.

Many of the hospital learners were discussing ways to justify purchases based on a Return On Investment analysis and several good points were made. I must admit my view point was challenged as well. When assessesing ROI projections from vendors understanding their starting point is crucial. Each vendor has the ability to mold the ROI to their benefit based on small feature sets that differentiate their product. Establishing your goals associated with a return is crucial. It may be beneficial to engage a firm or team with outside perspective to help establish the correct principles.

You also need to assess - if we are reducing work in a process what is the person going to do with the additional time and how is that improving the overall picture. If you simply add technology to save time - you have to decide prior to implementation what the new found time will be used for - if not you won't see any global productivity changes.

Technology Infrastructure
I was enlightened to the world of "Healthcare IT Consultants" during this visit. It's a broad term that can be interperted in several ways. Some are focused on the low voltage aspects, while others are focused on the technology, and others are foucsed on the transition. While my initial perspective was - you don't need them just evaluate the products you are presented with associated with your needs. At the end of the conference - I am convinced that a technologist is needed during a construction process. As a former vendor, who didn't appreciate the consultant, I now see that they are extremely valuable in decreasing the hospitals overall costs associated with purchasing and making sure that the workflow dictates the technology - not the other way around.