non-financial: speaker is employed by · gross savings on emobile transfer + icu stay $718,200...
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Luann Tirelli, RN, BSN, MHA, MSN/ED, CCRN-E, CNRN, NHCE VitalWatch eICU Operations Manager, Health First Corporate, Rockledge, FL [email protected]
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Non-financial: Speaker is employed by Health First Inc. located in Rockledge, Florida
Speaker will not be endorsing or supporting the use of any devices or products in this presentation
Financial: Speaker has a signed agreement
with Philips Healthcare and will abide by all stipulations specified in this binding legal agreement
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• Describe the Health First VitalWatch® eICU® eMobile Cart program
• Assess the value of mobile critical care for patient management
• Evaluate the results of the eMobile Cart program for improving outcomes and generating meaningful cost avoidance
• Recognize the potential of mobile critical care for use in other health care environments
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Central Florida's only fully integrated Health System
• - Outpatient & Wellness Services • - Trauma & Heart Centers • - eICU Telemedicine Services • - Multiple commercial & • Medicare health plans • - 4 comp. Fitness centers • -Area’s largest multi-specialty • Physician group • - Aging Services • - Family Pharmacy Center • - DME Company • - Private Duty services • - Wound Care/Hyperbaric • - Sleep Centers
*900 Acute-care beds *345 Progressive-care beds
*Trauma Center *VitalWatch® eICU®
Cape Canaveral Hospital
Palm Bay
Hospital
Holmes Regional Medical Center
Viera Hospital
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• VitalWatch®eICU®– a remote ICU team – Intensivist Medical Director - (1) – Operations Manager/Director - (1) – Critical Care Intensivists - (16) – Critical Care Nurses - (18) – ePharmD Clinical Specialist - (1) – Health Unit Coordinators - (6) – Physician/eICU Coordinator – (1)
2004 Health First establishes VitalWatch® First eICU in the Southeastern U.S. Monitoring of all Health First hospital ICU’s >60,000 Patient interactions a year
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• 2003 – Rapid Response Teams (RRT’s) – Institute for Healthcare Improvement (IHI) – Evaluate patients who suddenly deteriorate
• Health First RRT (2003) – ICU Nurse – Respiratory Therapist – On-site Physician or Hospitalist
VitalWatch® eICU® (2010)
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RRT historically at Health First Challenge – Collaborative care delivery in a timely manner VitalWatch® eICU®to the rescue System-wide approval – MEC/Executive Team System-wide education Change in eICU team workflow
BUT HOW?
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Downgrade Throughput
Support by Telemedicine: -Connected to VitalWatch® eICU® -All four Health First hospitals -Wireless Mobile Carts -Secure HIPAA Compliant Network
eSNF Consults
RRT SUPPORT
Translation Services
ASL Services
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The eMobile Cart
Use of an AV communication device
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Which of the following would be a potential outcome of a eMobile cart program?
A. Reduced care costs B. Controlled care services & throughput C. Decreased inappropriate status upgrades D. Improved mortality E. Revenue generation F. Retention of Staff
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Concern: Will there be an increase in transfer to ICU’s using a telepresence platform?
NO Raw data analysis has shown that less patients
had an upgrade to ICU status when eMobile cart support was provided by the eICU team.
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RRT Evaluation of Patients without an Upgrade to ICU status
Year(Jan-Dec)
Total # eMobile- Assisted
RRTCalls
Percentage patients w/o
Status Upgrade
Total # Non-Assisted RRT
Calls
Non-eMobile Assisted
Percentage patients w/o
Status UpgradePre-eMobileCart 2009 311 27%Start eMobileCart2010 204 38% 205 37%
2011 249 36% 127 36%2012 209 34% 215 34%2013 218 33% 183 33%2014 244 39% 360 32%2015 263 35% 307 34%
Average 36% 34%
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Concern: Would eMobile cart intervention improve overall mortality?
YES Since the eMobile cart program start, patients
cared for by the eICU team have a lower incidence of expiration during hospitalization
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% of Expirations during Hospital stay for RRT patients
Year(Jan-Dec)
eMobile- Assisted RRTFinal Disp.:Expired
Non-eMobile- Assisted RRTFinal Disp.:Expired
Pre-eMobileCart 2009 n/a n/aStart eMobileCart2010 n/a n/a
2011 18% 24%2012 25% 50%2013 13% 20%2014 19% 19%2015 17% 17%
Average 18% 25%
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Concern: With investment in an eMobile cart program, can there be significant cost avoidance?
HECK YEAH!
Show me the money !!!
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Year (Jan-Dec)
# w/o Status Upgrade
Transfer costs *1
ICU Bed Cost *2
Med-Surg Bed Cost
1 day LOS N- Cost
Avoidance
2 day LOS N- Cost
Avoidance
3 day LOS N- Cost
Avoidance
Pre - eMobile Cart
2009 N=78 $39K $1,250 $300 $74.1k $148.2K $222.3K
Start eMobile Cart
2010 N=71 $35.5K $1,220 $300 $65.3K $130K $195.9K
2011 N=68 $34K $1,230 $300 $63.2K $126.4 $189.6K
2012 N=70 $35K $1,200 $300 $63.0K $126.0K $189.0K
2013 N=72 $36K $1,200 $335 $62.3K $124.6K $186.9K
2014 N=126 $63K $1,800 $600 $151.2K $302.4K $453.6K
2015 N=124 $62K $2,000 $900 $136.4K $272.8K $409.2K
2010 - 2015 Calculations 531 $265.5K $541.4K $1.08M $1.62M
2010 - 2015 Total Cost Avoidances (Transfer + Daily costs)
$807K $1.35M $1.89M
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Dollar Spent Analysis Calculation 2014 Value 2015 ValuePatients Managed without ICU Upgrade n=126 n= 124Savings on Transfer Patients w/o transfer movement x $500 $63,000 $62,000CA on Means ICU Stay Patients x ICU cost x Avg ICU LOS/d 2.6d $655,200 2.5d $620,000Gross Savings on eMobile Transfer + ICU stay $718,200 $682,000IT eMobile Budget IT Costs $167,000 $167,000Net Savings FY (Transfer + ICU) - IT $551,200 $515,000Return on Investment FY Net / IT Cost $3.30/1 $3.08/1
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What could be some indirect outcomes from an eMobile cart program?
Increased Staff Satisfaction
Increased Patient/Family Satisfaction
Increased HCAHPS scoring
Regional/National recognition
Revenue generation: outsourcing
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eMobile Cart program: It is an effective means of extending critical care expertise beyond the ICU setting
Synergy among different service lines
within a healthcare entity is crucial to an eMobile Cart program’s success
Linking tele-ICU support to an
eMobile program improves care delivery leading to optimization of human and material resources
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