How Brigham and Women's, Mayo Clinic, and more are bringing the ICU into the 21st century

Most ICUs 'no different than [they were] 50 years ago'

A handful of providers in cities across the country are implementing innovative plans to bring the ICU into the 21st century, Usha Lee McFarling writes for STAT News.

ICUs in the United States see six million patients annually, but a recent study published in Critical Care found ICU care has not substantively changed since the field launched in the 1960s. ICUs are "no different than [they were] 50 years ago," said Peter Pronovost, a critical care physician at Johns Hopkins Hospital. "There are stacks and stacks of machines with wires sticking out of them. It's chaos."

According to McFarling, one of the biggest problems is that the medical devices integral to patient care aren't designed to work together. Instead of monitoring patients harmoniously, the ventilators, pumps, and other medical devices "all try to outdo each other by beeping ever louder," McFarling writes, which contributes to alarm fatigue.

Yet "when physicians see the amount of math involved [in optimizing the ICU], they just scatter to the hills," said Marie Csete, head of the Huntington Medical Research Institutes. Modern ICUs are full of machines generating data: Just one patient can generate about 2,000 data points a day, meaning important information can easily be lost in the sea.

Chasing the 'smart ICU,' hospitals generate innovative solutions

Despite the challenges, some hospitals are finding new ways to ensure providers see critical information.  At Brigham and Women's Hospital, the ICU team is piloting a microblogging platform that enables all members of the care team to see messages relating to a patient. The goal is to promote better communication and reduce errors.

Meanwhile, Pronovost at Johns Hopkins Hospital is trying to create a "smart ICU" where, ideally, all the devices in the unit will be networked and monitored on an ongoing basis, curbing the number of alarms and easing nurses' workload so they can spend more time with patients. Other upgrades include sensors on beds and compression devices.  

And at the Mayo Clinic, Brian Pickering, a critical care physician, helped develop software that aims to cut down on some of the data overload in EHRs. The software, called AWARE, highlights the most important information a provider needs by organ system.

Meanwhile, third-party vendors are creating add-ons for EHRs, including one, EMERGE, that extracts data from patient records and alerts physicians if a treatment plan could harm a patient.

The University of California-San Francisco's ICU is similarly testing new technology: Patients can now use bedside tablets to share photos and personal information with providers, a move that developers hope will help providers treat patients as people rather than data.

Lingering obstacles

Sometimes, providers are an obstacle to implementing new technology. For instance, telemedicine can be used in the ICU to connect care teams with remote specialists, especially in small hospitals that don't have in-person access to such expertise. Yet many care teams were slow to warm up to telemedicine programs, and telemedicine systems are in place in about only 16 percent of ICUs in the nation, according to Craig Lilly, a critical care specialist at the University of Massachusetts Medical School.

Telemedicine has been shown to reduce ICU mortality rates, Lilly said, because it allows for an extra set of eyes on the patient. "Sometimes the nurse doesn't notice," Lilly said, "sometimes the nurse is busy doing other things, sometimes the nurse is too chicken to wake up the doctor at 2 a.m., and sometimes the doctor just won't listen to a nurse."

But "biggest hurdle to building a truly smart ICU" is restrictions on data sharing. "We all think we have this amazing data and we want to hoard it, thinking we'll monetize it someday," said Joe Kiani, founder of the medical device manufacturer Masimo. "I used to be guilty of that too, and it's unfortunately so shortsighted."

Kiana has since founded the Patient Safety Movement Foundation to help bridge gaps between medical device manufacturers. So far, about 60 of 100 key device manufacturers signed a pledge saying they'll share data from their devices, McFarling writes.

"I now see a future where everything’s connected," Kiana said. "Hospitals are finally having a eureka moment" (McFarling, STAT News, 9/14).

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