By consolidating information, automating data collection, and harnessing new cloud computing technologies, doctors hope to silence the endless array of alarms and inject efficiency and personalization into the critical care experience

Some healthcare experts believe it is time that intensive care units undergo a workflow redesign to improve the quality of care they deliver, while reducing or eliminating design elements that contribute to errors. Clinical laboratories have a stake in this redesign effort, as they provide medical laboratory tests for patients in ICUs.

“What I want to do for the ICU is what Steve Jobs did for the iPhone,” said Peter Pronovost, PhD, MD, in an article published in STAT. Pronovost is working to improve both the flow of information and delivery of care in the ICU of Johns Hopkins Hospital in Baltimore, Maryland.

Intensive care units (ICUs) are the last line for many patients between recovery and catastrophe. And yet, since the adoption of dedicated ICUs, little has changed in the way care is conducted and delivered, even given the advances in integrating clinical laboratory information systems (LISs) with hospital information systems (HISs), electronic health record (EHR) systems, and point-of-care testing (POCT).

As pathology testing and diagnostic treatments evolve, the data provided by these tests also is increasing, both from equipment within the ICU itself and diagnostics available through medical laboratories. This means that choosing the most effective treatment from an ever-growing list of options also means caregivers must consult an ever-growing set of data silos, checklists, and protocols.

Add in the cacophony of alarms, a lack of beds, and short staffing and it’s easy to see why spending time in an ICU is stressful for staff and patients alike.

Redesigning the ICU Experience to End Alarm Fatigue

A key area Pronovost hopes to address is ending what he calls “the alarms race.” When critical monitoring equipment doesn’t communicate, it must compete to be noticed or heard. The result is an endless barrage of alarms.

Peter Pronovost, MD, PhD (above center), works with medical staff on the Weinberg Intensive Care Unit at the Johns Hopkins Hospital. (Photo and caption copyright: Will Kirk/Johns Hopkins Medicine.)

Peter Pronovost, MD, PhD (above center), works with medical staff on the Weinberg Intensive Care Unit at the Johns Hopkins Hospital. (Photo and caption copyright: Will Kirk/Johns Hopkins Medicine.)

However, not all alarms are accurate or critical. In 2014, a Modern Healthcare article reported on steps taken at Boston Medical Center’s North 7 medical-surgical floor to combat the number of alarms triggered. Their protocols dropped audible alarms by 60% across the hospital. Patty Covelle, Director of Critical-Care Nursing at Boston Medical Center, commented on the improvement. She said in the Modern Healthcare article, “Before the rollout of the pilot, there were one million alarms a week across the hospital. Now it’s down to 400,000 a week. These projects will hopefully put us under 200,000 a week this year.”

Still, that number means an average of 19 alarms per minute across the hospital. “We have alarm fatigue,” said Rhonda Malone Wyskiel, a former ICU nurse at Johns Hopkins Hospital, in the STAT article. “We’ve become numb to the noise and start to block [the alarms] out,” she noted. Wyskiel further explained that having devices that integrated information and communicated with each other would increase the time ICU nurses have to spend with patients.

Consolidating Data and Communications to Boost ICU Efficiency

Even with alarms and monitoring equipment optimized, an ICU can generate a staggering amount of data. Brian Pickering, MD, told STAT that the 24-bed ICU at Mayo Clinic in Rochester, Minn., creates 50,000 data points a day. When this data is spread between multiple interfaces, reports, and devices, the chances of overlooking critical information increases, making it increasingly difficult to obtain a comprehensive view of the situations being monitored.

Integrating the various equipment standard in ICUs, and using analytics to highlight relevant data on a per-patient basis, could help to improve quality of care, patient outcomes, and lower stress for both medical staff and patients. Currently, two such systems—AWARE from Ambient Clinical Analytics and EMERGE from The Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine—are tackling the challenges of data consolidation from different angles.

AWARE functions like a dashboard, consolidating the patient data and organizing it by organs and systems to allow efficient decision making and ensuring that relevant data is always highlighted.

EMERGE offers two interfaces—one for clinicians and another for the patient and family. By organizing data surrounding preventative tasks, risks, and monitoring, the tablet app provides a comprehensive look at a patient’s critical care experience using color coding and filters to highlight relevant information.

Benefits to Patient Recovery and the Critical Care Experience

EMERGE’s family interface highlights another concern created by today’s chaotic ICUs—patient trauma. The Boston Globe article, “Hospitals Working to Make Intensive Care Less Terrifying,” reported that many of the same issues impacting the ability to provide accurate, effective care also create stress for the patient.

Many ICU patients are heavily sedated and might have already experienced trauma prior to admission. When you add a never-ending chain of alarms, a rotation of staff, and unexplained tests and procedures, patients might find treatment equally traumatizing. The article notes that Johns Hopkins found that nearly 25% of ICU patients suffer from Post-Traumatic Stress Disorder (PTSD).

EMERGE’s family interface is designed to help reduce the trauma of an ICU stay. It allows patients and family to ask questions, provide input on their care goals, and learn more about the equipment surrounding them using a bedside tablet. The app also allows family members to upload photos or take part in daily care activities to further personalize the experience and help staff get to know patients and their concerns.

As doctors work to bring ICUs into the information age, clinical laboratories and pathology groups might also benefit from integrated systems. Easier data communication between LISs, EHRs, data storage systems, and clinicians will further increase diagnostic influence on care decisions. Analytics capabilities also enable caregivers to compare diagnostics results to incoming patient data in-lab, thus facilitating treatment decisions and improving interventions throughout the episode of critical care.

—Jon Stone

Related Information:

Raising an Alarm, Doctors Fight to Yank Hospital ICUs into the Modern Era

Hospitals Working to Make Intensive Care Less Terrifying

Paradigm Shifts in Critical Care Medicine: The Progress We Have Made

Improving Patient Care in Hospital Intensive Care Units

Hospital’s Simple Interventions Help Reduce Alarm Fatigue

Do You Hear What I Hear? Combating Alarm Fatigue

Innovative Designs for the Smart ICU-Part 1: From Initial Thoughts to Occupancy

Innovative Designs for the Smart ICU-Part 2: The ICU

Innovative Designs for the Smart ICU-Part 3: Advanced ICU Informatics

Experts Work to Create ‘Smart ICU’

Penn Researchers Develop “Smart” Intensive Care Unit System Using Advanced Computer Intelligence