Alarm Fatigue Panel Discussion

Ring….Ding….Buzz……RING……DING……BUZZZ……RING……..

Medical Devices have been created to notify a care team if the patient condition has slipped outside of the desired parameters.  The alarms are essential to provide safe care for patients.  The challenge is that when a device cries wolf (even if it’s reacting the way it was designed to react) that the care team begins to become fatigued….the more fatigued they are the higher the risk to patients.

There have been a number of solutions applied to the issue – everything from large technology investments to seek a better balance of “right alarm, right person, right time” to centralized alarm command centers to reduce the interruptions on the floor to simply creating policies that enable consistency on how alarms are to be treated and reacted too.

Join Commission is focusing on challenges to the care teams caused by ALARM FATIGUE. 

I will be hosting a panel discussion providing the HOSPITAL perspective…no vendors....at the 5^th Annual Medical Device Connectivity Conference

 Panelist:

Jennifer Jackson, Director of Clinical Engineering & Device Integration

Cedars-Sinai Medical Center

Marni Chandler-Nicoli RN, MPH, Intensive Medicine Clinical Program Manager

InterMountain Healthcare Clinical Operations

 

 Click here to learn more and register to join us!

http://tcbi.org/mdc2013/

 

 

Alarm Fatigue Revisited

Here is a little throw back from one of our most popular posts! I know it can be searched but thought you all might enjoy seeing something from 2010....

 

Wednesday, September 15, 2010

Alarm Fatigue

I was cooking a BIG meal – one with several burners going, the oven on, and even the microwave.  It was one of those “Martha Stewart has nothing on me moments.” (Ok, I was really more like a I'm a tall version of Rachel Ray) There were 4 boys running in and out asking questions and trying to “help” - other kitchen noises like the garbage disposal, can opener, food processor plus of course the TV was on in the other room. It was loud - like the Chiefs Stadium when we beat the Chargers on Monday night – LOUD! The point is I had a lot going on and neglected to set the egg timer for one of my pans and ignored the beeping on the oven……all of this to say we ended up eating at Culvers that night.

My kitchen scenario is much LESS intense than a nursing floor. No one was critically ill, there were no emotionally distraught family members, there was no Code Blue – it was a kitchen. (Well, the food was critically ill by the end of it – I digress) The point is think about your most intense - loud - busy moments and then think of how much more intense - loud - and busy the nurse is and you will begin to understand  “Alarm Fatigue”.

On a floor with 30 patients with IV pumps, nurse call, telemetry, other physiological alarms, etc there is bound to be some noise. The current methodology of listening for an alarm can really hinder productivity – but leave productivity out of it – it is a major safety concern.

Let’s take an easy one - Do you know the most common way we document a response to an IV pump alarm? The patient has pressed their call button and the nurse is notified that the IV Pump was dinging in their room. Think about how scary that is for a patient and their family – who has no idea what the dining means. Do you know the most inexpensive way to fix that problem? Automate an IV pump alarm to the caregivers wireless and explain to the patient and their family what will happen if the alarm goes off. (BTW – repeat that information every time you enter the room for rounding.)

Here’s a freebie - Depending on your nurse call system there is generally a quarter inch jack that can take a contact closure alarm – old school – this is the way my Dad did it when he sold nurse call in the early 1980’s. Order the cord you can use it tomorrow in your hospital. IF you have a question (hospital) – call or email me I will walk you through it. There are much more expensive ways to automate these as well.

The challenge is at some point in alarm automation and “management” you simply begin to displace the problem. If a clinical alarm device is trigger happy then your wireless device will be as well. Too many alarms is still TOO MANY ALARMS – just because it’s quieter on the unit does not mean its better. At some point it’s time to really review the technology that is making the alarm happen, AND review the process of who is getting what alarm when and why. The event in Boston was not due to the alarm noise, really it wasn’t even due to accountability because no one “heard” the alarm. The Critical alarm was turned off and the Warning alarms were ignored. Some automation would’ve helped the issue but it may not have solved.

Patient safety officials across the country have said the heart patient’s death at Mass. General shines a spotlight on a national problem with heart sensors and other ubiquitous patient monitoring devices. Numerous deaths have been reported because of alarm fatigue, as beeps are ignored or go unheard, or because monitors are accidentally turned off or purposely disabled by staff who find the noise aggravating.  ()http://www.boston.com/news/local/massachusetts/articles/2010/04/03/alarm_fatigue_linked_to_heart_patients_death_at_mass_general/?page=1

It’s tragic that a death occurred due to an alarm issue, and no family should have to go through that.  That death should be a rally point for all of us in the device industry.  

Define the Strike Zone

As a working mom with 4 boys juggling soccer practices, games, school events, and career can be really a challenge….but it’s what I signed up for when I took on this CEO role.  A few months ago, I was fortunate enough to get done early with a meeting in and grab a flight home to make it too Tucker’s baseball game.  I was glad I made it, because there was a great learning moment…..

Tucker (aka #2) stepped up on the mound and took his first warm up pitch….zip! It flew right over the catchers head and smashed into the fence causing the parents to jump.  He shook his head….frustrated….and quickly he took his next pitch…..ZIP! This time harder.   Still over the catchers head.  A mother behind me exclaimed “Someone needs to tell that boy not to throw so hard or he might injure someone.”  I bit my tongue, my response would have been “Lady wrap your kid in bubble wrap and let’s play ball.”  Instead I stood up and walked over to the fence saying “bring it down Tuck” and the mom whispered her remaining comments to her friend. 

If the other team didn’t have such an affinity to swing at high outside balls, then it would’ve been a looong inning.  The umpire held true to the strike zone so every batter went to a full count.  Fortunately, the young batters just liked to swing the bat so the inning ended quickly.  He headed to the dug out – head hung low – and sat down. 

I walked over to check on him “Hey Wild Thing are you ok?” (He didn’t understand the movie reference, but it made me smile)

“My pitches were high.”
“It happens…. sometimes we make mistakes – just bring your pitches down.  He was calling a generous strike zone -”
“But mom, it’s not my fault!” Tucker interrupted me “I didn’t expect to pitch tonight, my Dad wasn’t here to warm me up, and the coach made me clean up someone else’s mess.” 
My eye brows raised….for those of you that don’t speak Kourtney my eyebrows are my “tell” (I will never be able to play poker)… “Excuse me – whose hand did the ball leave? Who threw the pitches?”
 “Me….but”
“Tucker, you threw the pitches – you are responsible for the result.  It’s not enough just to get it over the plate – it has to be in the strike zone.  Now quit complaining and get ready for the next inning.”

Every Pitcher knows that his goal is to throw the ball over the plate in a way that the batter will swing at it (and hopefully not make contact).   It’s a universal understanding for baseball.  The umpire provides the detail on what and where he should focus – the umpire sets the actual strike zone. 

In the same way, every hospital knows that their strategic goal is to have satisfied patients, satisfied employees, and provide quality service….this has been the edict for years.  (Those goals should be the same for every business)  HCAHPS are not a new or revolutionary understanding of providing care that satisfies the needs of the patients.  HCAHPS simply defines the strike zone.  Instead of the general idea of throwing the ball over the plate – we must have “satisfied” customers – HCAHPS provides categories and expectations.  (We can all debate the validity of using “always” but that’s a blog for another time.)

Additionally, HCAHPS defines personal responsibility for our employees and a structure to hold them accountable for those actions.   Tucker threw his pitches high and outside – he was responsible for the every pitch he threw – good or bad.  He had the best intentions to throw a strike, but when the pitch left his hand….it was off the mark.  As his quasi coach that night, I was able to observe be outside the interaction from outside the field.  When he got to the dugout, I provided instruction based on his actions….in essence at the “point of care” I was able to instruct him on his next action.  In the weeks that followed, he pitched to me in the front yard and I could coach him based on his need.  (Did I mention I was a catcher for 10+years…poor kid)

As leaders in our organization it is important to engage during the work day – providing insight into how our team can improve what they are doing based on our outside perspective.   It’s critical that we create coaching moments outside of the heat of battle based on the information collected….Tucker throws a lot of high pitches.  I observed his grip, release, and stance during the game and was able to coach him in the front yard towards a better pitch.  You as leaders need information about how your employees serve your clients - defining not only what your expectation is but what your clients expectation is to find ways to continuously improve.   

 

Are you coaching your team to a better result? 

Do you have the information to be able to do so? 

Do you know what your patients except and are you meeting those expectations? 

Are you depending on post discharge data where the patients view of care has "settled" from the actual experience?

Are you comparing their feedback with the actual to define benchmarks? or do you set arbitrary benchmarks based on your gut feel?

How are you daily engaging at the point of care - gathering data, providing information, and creating coaching moments?

 

Margin

I grew up in a family where the expectation was clearly set that you would advance in knowledge beyond what the teacher was teaching at school, the preacher taught on Sunday’s, or any coach could provide.  It was your responsibility to grow in wisdom.   I have carried that thru into my adult life by maintaining a daily “quiet time” to read, study, and grow - setting aside 45 min to an hour each morning. (which happens to be the quietest time available in a house with 4 young boys.)  

A few weeks ago I started a study called “Balancing Life’s Demands” which discusses mental, physical, emotional, relational and spiritual balance.   The study uses the word “Margin” and defines it as the difference between what needs to be done and the time you have to do it.  I will have yet another birthday soon….not real thrilled about it…..so the identification of what one would call balance or margin is becoming a more focused effort.    

The ironic part of this life assessment is over the past 14 years, I have consulted with dozens of hospitals on defining margin for their organization. I analyze the obscure data generated by specific variable workflow activities and give recommendation on utilizing technology to enhance it.  The software we developed automates much of that process and enables continuous improvement.   Aperum uses data visualization to identify the often misunderstood work load driven form theinconsistent demands on their care teams generated by patients.  

I keep telling myself this life assessment should be a no brainer - life margin should not be elusive or nebulous.  I have built an entire business on designing “at a glance visuals” – where the metric quickly and effectively means something to an organization. However, it’s easy to say “I prioritize my family and church first” but if you look at the quantifiable data of hours spent per week – it’s not really a balanced metric.  (Same is true in nursing if you analyze where they spend the most time – you will find it’s not at the bedside so the perception is the main priority is not “direct” patient care….but that’s another blog.)

Strangely enough, I was a week or so in to this new study when Ed Marx posted his blog Bank Life, Not Vacation Days.  I loved that he had thought of a metric for evaluating whether or not he was in check for his commitment to balance – PTO hours accumulated vs PTO hours used.   A simple and easy to define number that encompasses a lot of information.  That’s the key – everyone knows that you have fewer PTO hours than you do total work hours – so it’s not a 1 for 1 equivalent.   It’s a predefined measurement of additional time away from work. Our payroll company generates that automatically and posts it to our online account – I honestly have never looked at it.  Not because I am pretentious and think the walls would fall down without me (I travel enough to know that my team has the operations side handled).  Mainly, I love work and I don’t really think about it unless prompted by my husband that a vacation would be nice.  I took a look after reading his blog…..let’s just say I booked a vacation next month. 

Thanks Ed.

If you are in Health IT and are not familiar with Ed’s blog  –CIO Unplugged –  he is a consistent blogger that has a way of communicating things that present more than just HIT initiatives – he gets “real”.

Community Garden

Recently, we had planting day for the community garden in South Kansas City.  Six months ago when I was asked to serve on the board of a local ministry, a community garden was not in the job description……a point I keep making to the group and I am sure they are tired of hearing.    Luckily, the garden has a fearless and passionate leader in Cama Suess (and her ever supportive and able husband Chuck) who pushed ahead and pulled me a long.  I am so glad she has done that…..

There are two aspects of a community garden.  The most apparent, it's a garden, a place to grow food to supply the need of those in need with healthy fresh produce.   It's an environment where we can do more than offer processed non-perishable food items.

A few years ago at the Cerner Conference there was a lot of buzz about “health and care” and the distinction between the two words.  We talk about solving the problems of healthcare thru better documentation, better technology, better process but a lot of solving the problems of our health system is by improving the health of the general public.   Often healthy living is reserved for those with means – it’s less expensive and easier to fill up a family on pizza rolls then it is to buy and prepare fresh food.   Food pantries are filled with the “helpers” (hamburger, tuna, chicken), canned meats & vegetables, and other processed non-perishable food items.   Not that they aren’t important but I keep thinking we can do better.

This garden will feed about 40+ families with fresh produce this summer.  It has corn, green beans, tomatoes, okra, squash, peppers, zucchini, and melons.  We plan to hand out recipes and cooking instructions with the produce.  

The second aspect is community.  This garden is about creating a sustainable renewable effort to provide an environment to serve others.  It’s a place to connect.  It’s a place where people can learn how to grow their own food while tending a garden.

On planting day, I gardened next to seasoned veterans who shared insights that you just don’t get on Pintrest. I shared a shovel with people who grew up in rural areas and have grown their own vedge for years.  I learned and so will others who work there this summer and in the future.

A garden has no boundaries, while we are a Christian ministry, this garden is a spot where people from any church, or any faith can come and serve the need of our community.  It’s about supporting a community of people – as my brother says “Being the change we want to see in the world starts with me”.

 I have launched a start-up with a zero dollar budget and had to be creative with this blog, twitter, and networking to get the word out, but I did it because it was the right thing to do patients.  It’s hard work.  As I thought about this garden – the expense, the work, the liability……the hard work…..I keep coming back to the same thought this is the right thing to do for our community.    That being said – we are getting creative to fund it and need your help. 

Please visit our Crowdfunding website and consider donating to the cause

http://www.faithlauncher.com/projects/184-south-kansas-city-community-garden#/

If you are in Kansas City - Be a part of the effort - come out and grab a shovel – visit the as I AM ministries – Outreach facebook page to learn more or visit our website www.asIAMministries.org

Thank you!

If not you….then who…..if not now…..then when.

Five Tips to launching Hospital Analytics

Hospitals everywhere are driving to a new era of Data. Some are jumping in head first to the bleeding edge technologies that promise to deliver value and others are waiting until it’s been proven before even putting their toe in the water. There is not a magic formula to healthcare data and analytics yet, but there are emerging best practices that should lead us all to more effective uses of data in our hospital environments.

Saint Luke’s is a 10 campus 1303 bed Health System in the Kansas City area. They are near and dear to my heart since I have delivered at their beautiful East campus. They are well known in the area for being high touch and high quality. I have had the pleasure of working with several of their leaders on projects and knowing others in the community.

Debe Gash has been the CIO of the health system since 2006 and has lead the organization to be well respected and win awards such as Most Wired, and recently lead them through the selection process of a new EMR. Debe has been on an Analytics journey for the past 18 months as the health system identifies and defines analytics goals and usage for their facilities.

“Health reform has driven an emphasis to analytics. Health Systems must perform as efficiently as possible while delivering positive outcomes. The only way to do this effectively is by using analytics” said Gash

1)   Get an education

Gash started her journey by seeking out wisdom of those who have been down the road before her. Her memberships at CHIME and the Health Data Warehouse Association have been invaluable resources for her to gain wisdom from her peers.

“The Health Data Warehouse Association provides webinars to its membership where my peers are presenting…not vendors” said Gash.

In a good peer group you can get the good, the bad, and the ugly without any bias or spin based on the vendors needs to sell to survive. While vendors have provided insight into the process they should not define how or what you are doing.

2)   Create a Data Governance Strategy Board

The phrase “death by committee” is a fear for many CIO’s with a vision. Saint Luke’s determined not only that there needed to be a committee who was well informed, autonomous, and had authority but they also needed to create a new role (FTE) for the organization to manage it all.

“We put in place a Director of Data Governance who works with committees to define, prioritize, execute, and evaluate our Data Governanceneeds“ said Gash

The team is comprised of key stakeholders who were committed to identifying things that could be improved by applying data.

3)   Create a Data Governance Strategy

Data Governance covers a whole range of topics within the overlying umbrella that is analytics. It is the rules and goals for the organization which allows identification, prioritization, application, and evaluation of the information.

The Data GovernanceBoard is responsible to define and maintain the following pillars of data management:

· Collection
· Storage
· Distribution
· Display

“People struggle with what should I look at and what do I need to do with it and why is it important? Our Data Governance defines all of those things for our hospitals so we can align system wide goals with system wide information.”

While the health system does use committees for subject matter expertise the core responsibility for data governance falls on theBoard and Director and they are accountable for compliance with the set standards.

4)   Select vendors only AFTER you have defined a process, and require compliance with your data governance.

Data and Analytics are the buzz words on every vendor’s lips. Vendors believe to sell their product they must have a “dashboard” or information display. The challenge is with multiple dashboard, and proprietary methods it is challenging to drive end user usage compliance. Saint Luke’s determined that vendors will be evaluated by their ability to conform to hospitals defined governances for data collection.

“Big Data is how you manage the data not the “what” it’s the architecture behind it.”

A common faux-paux of health systems is allowing vendors or groups within the hospital to define their own path for data evaluation. The hospital must create a single source of truth for all data, then a consistent metric for real effectiveness.

5)   Drive Compliance & Usage by creating organization goals for outcomes and operational efficiencies

The only way to drive behavior change and consistent usage is to attach economics that mean something to the individual or team.

“Our health system’s ROI is not determined by how much data is collected, or how great your dashboard is – it’s defined with what you do with the information and how you are able to impact patient care by increasing efficiency and improving outcomes.”

Through engaged leadership Saint Luke’s is working to drive meaningful change in their organization to improve patient care. Debe’s leadership has created focused culture of accountability using real data to make informed decisions. We will keep tabs on Saint Luke’s progress throughout their EMR implementation and launch of its analytic dashboards.

 

Hospital CIO series: Steve Huffman of Beacon Health System

I have decided to do a series of blog posts on hospital CIOs perspective on data and analytics and vendors…. I have talked to a lot of industry people (which has been fantastic fun and really great mentorship for me) but now really want to focus on what does the hospital want, need, think…..I believe that we, as vendors, focus a lot on what we think they want and what we think they need. In the world of analytics – there is a lot of newness so there is some providing them with what we “think”. However, how many times are you in a hospital each year trying to gain perspective from end users and from patients? How many times are you actively seeking to identify how your niche really applies to the day to day activity of the nurse or patient?

Recently, I was sitting at Denver International and playing on twitter. A CIO, who always is insightful, was posting a series of tweets on what not to do in a web ppt. As he published his disdain for vendors use of the popular sales medium (I was feverishly taking notes to send to @sphere3kyle) I thought – how many times do we as vendors believe we are enlightening a hospital. I was so inspired, I emailed him and he graciously agreed to chat on the phone with me – what ensued was one of the best conversations I have ever had with a CIO. Probably because I wasn’t selling a thing – I was listening to the perspective of someone who lives it everyday and was willing to share his thoughts.

Steve Huffman has been CIO of Memorial Health System – now Beacon Health System (South Bend, Indiana) since 2008. Prior to working for the health system he worked for the “startup” Medical Manager/WebMD. I rarely call someone brilliant but interviewing him was a lot like when I interviewed Tom Herzog….a wild ride of ideas and statements that each in its own could define an entire blog post. I will focus on a few in this post and maybe pull a few out for another.

One statement that stuck with me (as a vendor and business owner) was this “CIOs who spend more time with vendors than observing what is actually occurring with end users are doing it wrong.” I think back to that scene from Backdraft when Kurt Russell tells whichever Baldwin brother that is “You’re doing it wrong – if you do it that way it will fly open and you will die.” How many CIOs go from meeting to meeting and instead of engaging the end users ?  They are stuck hearing it second hand. If they continue down the exhausting path of being segregated from the actual floor experiences and perspectives of end users and patients...they will in essence die from project failure or burn out. As a vendor my mind immediately went to, how do I facilitate that process more effectively - instead of standing up with a ppt.....

Steve's next statement I will take to all my startup friends.  “Not everything can revolutionize healthcare, and that’s ok.” His cynicism has grown as every excited sales person stands up with a vision of a revolutionary change provided by their product. This is completely contrary to what every academic professor tells you when creating a “High Profit Venture” Steve’s contention was – revolutionizing healthcare cannot be done with a product – it can only be done by those who are working in the hospital. The change is not a technology – the change is an action and while it can be enabled by technology it cannot be caused by technology. Not even the EMR is revolutionizing healthcare, its recording data….which is good but not the change agent needed to meet the expectations that are coming down from the government.

The last thing I asked Steve was for a real world example of how analytics has impacted his career. This was the most exciting part of our conversation. An analytics team was asked by leadership to examine why they were having so many readmissions in the Emergency Department. They began observing and analyzing the EMR data regarding the consistencies of the patients diagnosis. “I was sure it was going to be heart related....”Steve had no idea how heart related it really would become to him. The consistencies were not related to a medical diagnosis that could be healed with pills, the consistent diagnosis was alcohol and drunkenness. So to reduce the number of readmissions, Steve began to seek out where in the community individuals with this challenge could go for help. He found that the local shelters did not accept people who had been drinking or were on drugs – even in the cold weather. That winter a man died in a garage due to exposure to the cold. Steve said “I didn’t hear the audible voice of God, but I knew that He was telling me – you know too much to do nothing.” So Steve and a small team had a mission and set out to find a solution. He and his wife and the small team set out to start a ministry to provide a place to sleep, eat, and be spiritually fed for the down and out of South Bend Indiana. Several churches stepped up to help. Now Steve spends his free time feeding the stomachs and souls of those in need.

For us an experience created a mission for analytics. For Steve an analytics created a mission.  Sometimes it's not about "revolutionizing" healthcare but it's learning to care for others. 

Follow Steve @SteveHuffmanCIO

Aone Day 2 Time Saving Medical Device Interoperability

I moved to the country....farther into the country than I already lived in my small rural town….I moved to “county”.  Outside the city limits, on acreage with a pond full of fish, land full of trees, and plenty of space to attempt to grow something larger than marble sized tomatoes.    We have learned about several things since we moved – most of which will turn into blog posts (bet you all are really excited for me to compare something to living on septic….and how much I miss the Pizza Hut delivery guy).   The biggest change for us has been time – it’s a drive to the nearest grocery, a couple acres to the next neighbor, etc.    I have started thinking – well that will take me an extra 30 minutes so I need to make this trip to “town” count.  I get very frusterated when I execute my shopping list incorrectly…I actually tried to make shrimp cocktail the other night because I forgot to pick it up – which didn’t work so I made a remoulade.     Time is our most valuable asset and we start to make decisions on what we will or won’t do based on how much time we have.

Yesterday, I posted about acuity management based on the diagnosis of the patient, and how it could be augmented by adding more information about the need that the patient is generating.   The time that you would save only happens if you balance the need index and the task list associated with caring for a patient.   Then clinicians can spend more time doing patient care and less time being interrupted. 

Today, I am posting about ways to use technology to save time.    There was a study released yesterday by West Wireless on the value of interoperability. http://www.westhealth.org/institute/interoperability  (if you go to this website you can download the full report in a PDF)  

Here is what I like about the report – it’s not written by a vendor…… West has nothing to gain by telling hospitals to invest in technology that makes medical devices interoperable with the EMR.  Second, it speaks to nursing workflow and the value of the nurses.  Did you know that nurses salaries account for $173 billion of heath care spending per year?   The report cites the 36 hospital time and motion study (It’s amazing how prolific that study has been in defining how nurses spend their time.) that indicates 35% of time is spent on documentation. (They uses a lower figure for their findings)   If I am making the correct assumption – 20% of a 10 hour work day is 2 hours per day per shift….that’s real savings.  It’s not 2 minutes or 10 minutes (always question when vendors give you savings of 10 minutes or less for a value add) The 20% they are referencing would allow for better patient care – more time at the bedside however they link it to a potential savings of  $12.3 billion dollars…..that’s where I have a slight issue.

Here is what I don’t like about the report – if I run a company that has people that I can save 2 hours per day doing a task that can be automated….the only way to “save” those dollars is to eliminate staff.  If you shift the tasks (remember yesterday’s blog – tasks associated with timeframes) then you can potentially have fewer people do the same “care.”  So, for example, to save money we would need to reduce staff by 1 which would equate to 8 hours of work tasks that need to be distributed throughout the workforce in some way.   Maybe I am looking at this wrong….but dollars and sense would say I have to reduce staff to gain the savings.

Reducing workload by 2 hours per day not only saves time but it also allows for a more time to engage with patients, do rounding, and patient centric care.   It allows nurses to engage in better patient care, more time at the bedside, and (as the study goes on to site) improve quality and safety.    The study sites a $36 billion dollar savings - $12 billion is nursing salaries.

Since it’s AONE and a number of nurse leaders have the ability to seek out new technologies that can aide in the automation of work flow of their nurses.   There are two that come to mind as industry leaders in the medical device interoperability (namely documentation)  Isirona (www.isirona.com/for-clinicians) and Capsule (www.capsuletech.com/our-solution-clinicians) . 

Isirona is three spots down from Sphere3 (we are in booth 727) stop by and chat with them.

We hope to see you today at AONE we are at Booth 727 and would like to introduce you to Aperum a mobile dashboard that allows you to identify not only the need generated by the patient but their current perception of their care.

AONE 2013 Patient Need Based Acuity

My husband ran a distribution center  for 13 years.  When we met had around 150+ employees and through automation, software, and workflow modification was able to reduce the employee count to less than 10% of that number.  His guiding principal was to break tasks down and manage the individuals according to the time it took an average person to accomplish the task.   He and his team could watch a process and identify skills sets and aptitudes that allowed them to manage the team to accomplish the goal in a timely way with a low error rate.

As I have researched acuity it seems to be a similar structure.  The DRG defines a grouping of tasks and the tasks have an associated average time of completion (geeks call this a weight) and the assignment is made based on how many “tasks” can be completed within a shift.  Then the patients are assigned to the caregivers based on the workload associated.  That’s when I started to ask questions….are we treating nurses like assembly line workers?   How does this affect how we assign them to a patient – does our technology really support the mindset?

I have watched this process at a number of hospitals, interviewed a number of managers and I do believe that it’s much more of an art than a science.    In the last few years I have also observed several production facilities - from a Milk Farm to a Coffee Roasterie to Electronics manufacture.  The thing that jumped out at me……the product or coffee bean or electronic doesn’t drive any additional demand or strain on an assembly workers day.  There are outliers where a piece of material is bad but for the most part it’s pick up the widget, put it in a box, etc.   The point is – the widget doesn’t ask for ice chips when you are trying to complete other assigned tasks....the widget dosen't code.   

I get it – there has to be a way to balance the workload of the caregiver and acuity (aka task management) seems to be the best method.  I am not trying to disregard the years of research and work done in creating the tasks associated with diagnosis, etc  but there is more here than just a task list.  We at Sphere3 believe there is a way to capture additional information to make assignment of patients easier and managing the workload more effective.  Stop by and check it out.

I am eager to see at AONE this week how many vendors try to tout their technology as a way to reduce staff….be careful with those statements…..technology should be an enabling tool the data should give the ability to manage the workload more effectively.  Patients aren't Widgets – Caregivers aren’t assembly line workers.   

If you would like to see how Aperum® can help your facility better manage workload of your caregivers stop by BOOTH 727 this week at AONE.

HIMSS Day 3... Day???

I have been on the road for a solid week now as most of us in the industry know kind of forgetting what my house looks like and hopeful that my boys remember my name when they see me.

Yesterday – I was able to enjoy the Cedars Sinai & Voalte presentation.  Most of you know I have an affinity towards Voalte..yes, yes, I am vendor agnostic but there are products that are disruptive, innovative, and extremely functional for nursing that shift the paradigm.  Or maybe it’s just the pink pants…..

The presentation was great – I tweeted it out and saw lots of people liking the thoughts.  Darren Dworkin is a real thought leader – I have had the pleasure of working with him and his phenomenal staff and have experienced firsthand their ability to grasp a concept and mobilize it (no pun intended).    Dworkin was humble in the revelation that Cedars has tried a number of different technologies to really find the right fits for their organization that also fit the fast changing IT infrastructure.  For communications devices they have landed on a more “consumer” type product – the iphone.    They have deployed more than 1000 devices.  I was most impressed with the statement that nursing came to him and said “we don’t want a batman belt” and IT listened to the end users and sought out a product that would not only be forward thinking but serve the nurses well.  He said that nurses don’t come up and tell you how much they love EMR but they do come up and tell you what a difference this device has made. 

My biggest disappointment yesterday was on the statements made by Epic.  I have debated whether or not to post anything (when you are a startup it’s better not to ruffle too many feathers…which I tend to do with Cerner on occasion.... ) but for the few of you who read my blog you know it’s my opinion. 

I didn’t like their statement.  I understand they got bad press because they weren’t sitting there on stage from the beginning.  I also understand that it appears that they are being strong armed into the party – twitter and speakers are brutal and love a good bit of drama and gossip..we are all grown ups and can see it.  I also understand how they could take this as a competitive movement…. 

But OH MY WORD…CAN IT JUST BE ABOUT THE PATIENT FOR ONE DAY IN HEALTH IT?! 

Why not say – we weren’t invited to the party but we think this is an idea worth exploring because we believe in patient care.   Then take a look and if it’s not a great idea – make a statement then.  The point is can't they just sit down and talk about it.....somehow they got Neal to sit next to Jonathan Bush (which was visually awkward) but they were there willing to talk. 

I don’t know Neal personally – I don’t know the other men on the stage (I met Jonathan Bush…and wow still not sure what to think of him)   I have to believe – that somewhere each of these men have some part of them is good intentioned enough to believe that CommonWell is really what it says for the Common wellness of patients…….

I am weary – weary – of going to events and seeing so little about the patient – seeing the vendors latch on to analytics because it’s the next hot topic and it will “save money” and it will “improve your efficiency” – they need something new to sell.  I just want them to know you won’t be able to really love analytics  and serve the hospital well until you step back and see the people in the numbers. 

Ok, soap box complete for Day whatever it is....

 

 

HIMSS Day 2 & Histalkapalooza

My goal with HIMSS is generally to have meetings, see the vendors, and get inspired and rejuvenated for the next 11 months – being with 33K other geeks really helps me get refocused on what is really “innovative”.    However, as John Moore (@John_Chilmark) tweeted there are a lot of “Me toos” and at HIMSS.  It’s true you can see the wide  red ocean of nothing new being under the sun.  Or people thinking they are disrupters but really they are noise makers in an already disrupted space.

The booth that I was able to spend the most time in (ironically since I live less than 15 minutes from their Innovation Campus and pass it on my way to work every day – I hoped on two airplanes and a taxi to see them here) was Cerner.    Their Care Connect area was very impressive.  I am still a huge fan of  Mystation (even though it’s still not on an IPad where is should be).  I like the concept of driving more patient understanding and engagement throughout their care process.  This is something that could follow them home and be part of the home health model....not sure if she said that but that’s where my mind went.   Ashleigh showed me the Care Connect mobile device area.  It’s not easy to give a concise presentation that shows how really powerful a tool is and she did a great job.  If you have time stop by and ask for her.   The tool lets you see not only your patients but their status it’s a really nice blend of EMR with alarm notification information.  

I popped into the Hil-Rom booth – and got the standard – “who are you and why are you here”  after saying who I was I told them about the blog and one replied “yes only if you write nice things about us….”  (that should be the number one thing not to say to a blogger – it just makes it tempting to write less than flattering things….) I will do my best.  The challenge with nurse call is since it’s hardware and we live in a software world – it looks the same for a number of years before a new system comes out….same is true for Hil-Rom – it looks the same as it did the last couple of HIMSS.   However, they did make a statement which perked my interest – that “we don’t need middleware” – I think I am going to work on a post called “the death of middleware”.    It’s true – most nurse call light systems don’t need middleware but the implication from Hil-Rom is that they were middleware with the ability to automate information from their bed, their fetal link alert system, and their nurse call…..so that’s where you get the ding…..it’s not about “your” anything in middleware it’s about “their” everything.  So long as you have a single vendor ecosystem you can achieve what they described – kind of like how EMR sells their interoperability.  

I stopped briefly by Rauland - same as Hil-Rom the hardware just is what it has been for the last few years.  However, their newest software addition is Responder SYNC.  I have heard people call this single sign on...which I say kind of.  Sync claims to deliver on the promise that the alarm notification world has been talking about for years – Single Assignment.  Middleware claims this service by allowing a single point of assignment for multiple devices but as everyone knows that doesn’t really “sign you in” to nurse call – the lights and the tones do not follow the middleware assignment.   From what I saw - the greatest benefit to SYNC is the ability to sign on using EMR.  You are still limited in who can do this (Connexall and Cerner have made the interface) but evidently it's "open".     Stop by and ask about it - it's worth the converstation.

In general the floor seemed very steady but not busy – not the shoulder to shoulder crowd we sometime experience at HIMSS – but it was steady.  I did hear several vendors say there were fewer people….

My evening ended at the HISTalkapalooza event – I was not fashionably late.  I saw some amazing shoes (especially @TIMURDC which were my favorites) and was able to chat with lots of interesting people including the folks from Dr. First – I am going to see their booth today because it sounds amazing.   I chatted with Jonathan Bush about his lack of ability to score soccer tickets while sitting next to Neal Patterson….  I ended up on the front row of the prizes and was able to snap some fun photos....  the one of @Farzad_ONC has been retweeted a lot.  As I left, once again ran I into Judy from Epic.  Thanks for the invite Mr. H.

 If you have time today - I am speaking at the Burwood Booth 5019 @ 3:15p  come check it out.

 

 

HIMSS Day 1 Clinical & Business Intelligence Symposium

Well, HIMSS13 has started off…..interesting in both good and bad ways.  After having some hiccups getting my morning caffeine fix (thank you to the HIMSS staff that helped me find the Starbucks at the Marriott) I headed to the Clinical & Business Intelligence Symposium.  Then at some point twitter began to show signs of a problem....water....the symposium leaders announced that we could not  drink the water.  This wasn't too bothersome until they announced that they were manually going to be flushing toilets with buckets of water ....I suddenly wished I wasn’t so hydrated……some tweets made me laugh (especially @SteveHuffmanCIO) but I must admit the people running everything didn't miss a beat and handled everything very well.

 

For me the water issue - while concerning - didn't deter from the Symposium - more gave a room full of geeks something to talk about other than the weather.   The Clinical & Business Intelligence Symposium was a not focused on a specific “type” of data – it was a well-built process that took us from defining to analyzing to improvement.

 

Each presenter took a different segment of the process of defining, analyzing, and improving using data in a meaningful way.  They gave applicable advice that any hospital could use if they were planning to head down the business intelligence route. Brian Jacobs, Children's National, (and others used the same definition) gave the following definition.

 Workflow‐integrated information which enables healthcare providers to drill from reports into detailed analyses of quality, safety, efficiency, effectiveness, regulatory and financial aspects of care practice to identify poor quality, waste, non‐standard practices, under or over‐utilized services, & opportunitiesfor improvement.

The most surprising thing for me - all of the presenters recommended that the BI group of the hospital NOT be under IT.   That while there are governance's and processes that are IT enabled it should be reporting directly to the Executive Team.  (Namely the COO)  Also that the area seemed so nebulous and undefined - I appreciated John Glasers statement that we had a lot to learn and will continue to learn and adjust the field because it's just that new.

The room was pretty mild - except for one woman who decided to soap box about how far behind the US was from other developed nations.  The presenters handled it well and while I am not ethnocentric and understand we have a long way to go - it struck me wrong that someone would sign up for a course that was to introduce hospitals to the "how to's" of doing business intelligence.  The presenters handled it well and we were able to move on after her dissertation.

Like usual I met some great people –  and even have a devoted KC Chiefs fan talked into joining me for a Sporting KC game.  (BTW – SKC won on Saturday!) 

 Today, I am going to meet with some good friends and check out several vendors and give some thoughts on the blog – if you want me to pop by send me a Twitter message @Sphere3CEO

Also will be at the Histalkapalooza tonight!  So excited.

Bed Alarms Don't Work??

I recently read a blog by KevinMD – a blogger I really enjoy following – regarding the use of bed alarms and their lack of ability to reduce fall rates.  (http://www.kevinmd.com/blog/2013/01/bed-alarms-work-reduce-patient-falls.html)

I found his blog very interesting (especially since we now interface more fully with smart bed technology).  So being the nerdy geek I am – I did some investigation.  The blog is referring to a study done that compared falls at a single ubran hospital over a period of time.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549269/

The simple summation is that “bed alarms” do not have a significant impact on reducing falls in a hospital. 

When someone says “Bed Alarms” they are generally reffering to any type of technology that notifies the caregiver that a patient has exited the bed.  So the technology itself is anything from a pressure pad to smart beds.   The study referenced was conducted using pressure pad type of alarm with two weight sensitivity settings.

Most pressure pad looks similar to a strip of material that is laid under the patient on a bed, to integrate it to a call light system (ie having the centralized notification) you plug it into a quarter inch jack. (A quarter inch jack is like a phone plug from the old operator based phone system where you crank the phone the operator answers and then physically connects your call to another)  The technology is a contact closure – it is “on” of “off”. 

The study used a pressure sensitive pad that is placed in the bed or chair.  So, if you scoot to the edge of the bed but keep the pressure applied to the pad then you will not trigger an alarm until the patient falls on the ground.   Or commonly when they are sleeping and the patient arches their back to adjust their gown, the alarm goes off – thus alarming and waking the patient.  (which would link to that whole “noise at night” issue with HCAHPS)  Further, this type of technology is prone to false alarms which can be linked to alarm fatigue situations. 

However, more modern “bed alarm” technology, such as Stryker’s iBed, allows the bed alarm to be triggered based on zones and weight of the patient.  There is an actual algorithm that evaluates the patient’s weight to determine where the center of gravity is located.   The cool factor here is that instead of an “on/off” technology it uses the potentially varying weight fo the patient to engineer a more precise alarm to indicate when the patient is moving TOWARD exit.  This does two things, it notifies prior to exit and reduces the occurrences of false alarms.  Think of it like the Indiana Jones scene where he replaces the idol with a bag of sand and it triggers the cave in. 

Some of the smart bed technology work on a similar assumption where a variation in weight triggers the alarm, the reason I think that Styker’s is so effective is that the “weight” is actual.  Most beds look for a shift of 20lbs or so but do not take into account the actual weight of the patient.  If a patient is 90lbs and 20lbs moves that significant if the patient is 300lbs and 20lbs moves that may not be as significant.

In the Styker product, the clinician determines the level of sensitivity.  It can be based on acuity or a fall evaluation.  The level of sensitivity will actually measure the movement of the patient TOWARDS egress not at the point of egress.   

So, do I agree with the study – yes, it appears that the technology that was evaluated in the study had little to no impact on the patients fall rate.  Do I agree that “bed alarms” as a category are ineffective? No, I don’t think technically that is the best assumption.

I do agree fully with KevinMDs statement “Maybe we need to rethink hospital fall prevention, and focus on more human and less technical solutions.”  

A bed alarm – like any medical device or alarm notification technology should be part of a more comprehensive plan – technology alone does not solve.  Think of it this way – if you buy a treadmill and just look at it, it won’t improve your health.  If you buy a treadmill and walk on it every once in a while….it won’t improve your health.  If you buy a treadmill and run on it every day but eat cupcakes every day….it won’t improve your health.  The “treadmill” is not the answer – the “treadmill” is a tool to be used in conjunction with behaviors and habits.  

Check out our clinical blog.  (www.sphere3consulting.com) where CNO Lynn Barrett discusses some of their holistic approaches to reducing falls.