Remote Presence ApplicationsRemote Presence ApplicationsInternational Distributor’s Open House

PatientPatientSatisfactionSatisfaction

Anytime Anywhere Care

HospitalHospitalThroughputThroughput

PhysicianPhysicianEfficiencyEfficiency

PatientPatientSafetySafetyRemote PresenceRemote Presence

Patient Ward RoundsPatient Ward RoundsCritical Care UnitsCritical Care UnitsEmergency DepartmentEmergency DepartmentRemote OutreachRemote Outreach

Advances Key Hospital InitiativesAdvances Key Hospital Initiatives

ICU Remote Intensivist Coverage

• Overview– ICU care is 4x more expensive than M/S care– ICU spending = 1% of GDP– Fast pace, complexity and severity make ICUs the #1 in medical errors– Intensivist-led care is proven solution, but nationwide shortage exists– Remote Presence can deliver intensivist coverage across multiple ICU’s

• Objectives– Meet JCAHO, IHI, Leapfrog patient safety standards

• More frequent intensivist and daily team rounds• Ventilator, BSI, and sepsis care bundles • Rapid Response Teams

– Reduce clinical outliers• Value Proposition

– Compliance with national patient safety initiatives– Reduce ICU LOS by 18% ($180,000 per bed annually)– Reduce ICU admissions by 15% ($65,000 per bed annually)– Reduce ancillary costs by 15% ($26,000 per bed annually)– Reduce ICU mortality by 40%

Problem: 20% of ICU patients experience serious adverse events,Problem: 20% of ICU patients experience serious adverse events,Over 54,000 ICU deaths could be prevented each yearOver 54,000 ICU deaths could be prevented each year

Parkview HospitalEvening Admission

Parkview Hospitals

• Achieve compliance with IHI standards– Team rounds and spot checks enable 100% compliance on vent bundle

• Reduced VAP to zero saving $30,000 per case

– Rapid Response Teams reduce “out of ICU” codes from 6 to 1 per month• Off-ICU codes have 40% chance of survival and average cost $215,000

• Achieve compliance with JCAHO standards– 100% restraint protocol compliance saving $100,000 resurvey

• High nurse and staff satisfaction– 25% improvement in staff satisfaction

– ICU job vacancy down from 20% to 5%

Remote ICU staff covers 5 hospital ICU’s and patient wards in Ft. Wayne, Indiana

UCLA Medical Center

• Daybreak rounds, daytime spot checks, proactive evening rounds– Improve education & supervision of residents

– Improved ICU bed turnover due to more rapid off-hours triage

– Faster attending-level treatment decisions on critical care patients

– Increase compliance with ICU standard protocols

– Improve nursing and family satisfaction

Increased neuro-intensivist coverage in academic hospital settingIncreased neuro-intensivist coverage in academic hospital setting

California Pacific Medical

• Remote access to pediatrics ICU from physicians offices & homes– Increased daytime and after-hours coverage

– Improved patient and family communications - increased satisfaction

– Convenience and satisfaction for physicians

Increased specialists coverage of pediatrics ICU and patient wardIncreased specialists coverage of pediatrics ICU and patient ward

“I used to sleep over at office just to cover my pediatric patients.”Michael D. Black, MD

Physician Rounds on Med/Surg Floors

• Solution– Connect targeted physicians from home, office, sister hospital– Currently: Urology, Bariatric, Cardiac, Orthopedic, Neuro,

Parinatology, Burn units, pediatric units

• Hospital drivers– Reduce patient LOS by hours or even days

• Physician drivers– Improve patient satisfaction– Improve physician efficiency

Problem: Once daily physician rounds extends patient staysProblem: Once daily physician rounds extends patient stays

Hackensack UMC

• New rounding protocol– Robotic rounds used to deliver discharge orders before 11AM each day

– Reduce PM discharges by 80% - improve efficiency & throughput

– Physicians reimbursed; study used to support new reimbursement code

• Hospital financial benefit– Each PM discharge equates to 1 lost day or $1,000

– Robotic AM rounds can release 25 additional beds

– $9 million annual benefit to hospital

25 patients/day are unnecessarily discharged in PM instead of AM hours

Dr. John DavisUrology Post Surgical Rounds

Devine-Tidewater Urology

• Urologists perform supplemental afternoon rounds on 62 post-surgical patients

• Financial impact– In a 42 bed ward, the est. value of .29 day LOS reduction exceeds $1.4 million/year

• $508,000 marginal cost savings (1270 fewer days for current patients)

• $989,000 marginal value of 396 new patient admissions

Robotic Rounds Totals Percent

Medical orders provided 40 65%

Discharge orders provided 12 19%

Patient discharge advanced 18 29%

Supplemental robotic rounds reduces hospital LOSSupplemental robotic rounds reduces hospital LOS

Sinai Hospital

• Robotic rounds in bariatric surgery– Increased patient throughput– Cost savings and increased revenue for hospital– High patient satisfaction leading to increased referrals– Higher case volume and high physician satisfaction

Reduced LOS, increased throughput and high patient satisfactionReduced LOS, increased throughput and high patient satisfaction

“I do remote rounds as often as three times a day. Currently, 80% of my patients are being discharged on post-up day one.”

Alex Gandsas, MD

“One night when I was feeling low and worried about my health, Dr. Gandsas, visited with me through the Robot in real-time! That’s what this represents – peace of mind for patients”

Name Withheld

ED Specialty Consults

• Solution– Connect key specialists from home, office, another hospital,

elsewhere in the hospital (cath lab, ICU, OR)• Clinical drivers

– Cardiac program – timely cardiologist– Stroke program – timely neurologist– High risk pregnancy – timely parinatologist– Address ED delay JCAHO/Patient safety risk– Improve continuity for ICU bound patients

• Business drivers– Solution to ED Call Panel issues– “30 Minute Guarantee” marketing campaign– Reduce hospital diversions (4 lost admits/ hr)– Improve ED patient satisfaction

Problem: Long ED wait-times, survey risk, and call panel recruitingProblem: Long ED wait-times, survey risk, and call panel recruiting

Detroit Medical Center

• Provide timely ED call panel coverage, thereby improving ED efficiency and reducing wait times

• Active participation from cardiology, neurosurgery, pediatrics, general surgery, critical care, urology, perinatology & dermatology

• Reduce non-critical ED wait-time from as high as 12 hrs to 2 hrs

Improved ED call panel coverage and access to specialistImproved ED call panel coverage and access to specialist

Remote Outreach

• Solution– Connect specialist from ‘Host’ Hospital (ED, ICU, Other) to smaller

remote hospital• Rural (limited access) hospital• Single specialty hospital (without full set of specialty services)

• Clinical drivers– Shortage of specialty services in remote markets– Involve clinical experts earlier in treatment

• Business drivers– Drive specialty service referrals to Host hospital– Establish Host hospital system as market leaders– Enable remote hospital to avoid unnecessary transfers

Problem: Access to Expert CareProblem: Access to Expert Care

Detroit Medical Center

• New protocol– Harper Hospital intensivist manages MIOSH ICU patient from office and

home

• System benefits– Improve patient safety – reduce risk

– Leverage the DMC clinical capability to remote hospital

– Train/coach remote hospital team

– Avoid unnecessary transfer

– Improve continuity of care

– Improve patient satisfaction

Surgery outliers are high risk for distant orthopedic specialty hospitalSurgery outliers are high risk for distant orthopedic specialty hospital

Current Hospital ApplicationsIntensive Care• Increase Intensivist presence• Admission/discharge/transfers• Nights/weekends call response• ICU staff training and support• Resident oversight• Evening rounds• Family meetings• Rapid Response Teams• Code Blue Team• Leapfrog/IHI compliance• Leverage eICU teamSupplemental Surgical Rounds• Urology • Bariatric • Cardiac • Orthopedic • Neuro• Burn units, pediatric units Supplemental Medicine Rounds• Supplemental morning rounds• Geriatric roundsCath Lab• Cath patient recovery oversight• ED consults from Cath Lab

ED Consults• General surgeon• Pediatric surgeon• Urology• Cardiology – Chest protocol• Neurology – Stroke protocol• High risk pregnancy• DermatologySurgical Process• Pre-op anesthesiology patient exams• Neuro-surgery head positioningRehabilitation• Patient consults• Rehab oversightOutreach• Major Academic Hospital to suburban hospitals

or specialty hospitals• Larger hospitals to small rural hospitalsOther• Translation services • Isolation patient management• Night nurse in-service and education• Security• Surgical proctoring