i don't usually post threads but this one caught my eye. which cause this patient to have an untoward outcome. the hospital is calling it "alarm fatigue" and it's the nurses who didn't respond. but they have eicu where the is constant monitoring of the patients and the monitors by remotely located staff, like air traffic controllers watch airplanes.
who's job was it to watch the monitors and where did they all go? does anyone work at an eicu? what do you think of them......
the umass memorial health care system offers an extra level of care through the icu® program to patients admitted to intensive care units across our system, including umass memorial medical center and community hospitals healthalliance hospital, marlborough hospital, and wing memorial hospital, and affiliated hospital harrington hospital. (read related boston globe article).
the eicu program's specially trained critical care physicians known as intensivists use voice, data and video technology to enhance the patient care provided by the icu bedside staff. this attention to detail helps identify a potential concern in a patient's condition in the early stages, allowing icu staff to intervene with prompt treatment before conditions worsen.
because even the slightest change in a patient's condition could lead to a potential health problem, any sudden alert is instantly sent over the eicu program's high-speed data lines, notifying the intensivist to closely examine the situation. the intensivist can then activate a video camera at the bedside to visually check the patient's condition.
a soft chime and a green light displayed at the patient's icu bedside indicate that one of the icu monitoring cameras is being activated. the icu nurse, now at the patient's bedside, evaluates the sudden change in medical status by providing the intensivist with a verbal assessment. the intensivist can now communicate with both the patient and the icu bedside caregiver to better determine the cause of the sudden change in health status.
the second patient death in four years involving "alarm fatigue'' at umass memorial medical center has pushed the hospital to intensify efforts to prevent nurses from tuning out monitor warning alarms.
nurses exposed to a cacophony of beeps may no longer hear them or begin to ignore them, and that's what appears to have happened in the latest case: a 60-year-old man died in an intensive care unit after alarms signaling a fast heart rate and potential breathing problems went unanswered for nearly an hour, according to state investigators who reviewed records at the hospital.
edit 1643: some have been upset about the title....i have no intention of accusing nurses of killing anyone. just to start the dialog about eicu safety and nurses being the fall guy's once again....
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
This article, from 2007, describes the e-ICU set up.
This article, Sept. 21, 2011, describes the recent patient death (the 60-year old male) ... as well as another patient death of a female patient related to a dead battery in her monitor.
and this one from UMass itself.....
eICU Program
The UMass Memorial Health Care system offers an extra level of care through the eICU® Program to patients admitted to intensive care units across our system, including UMass Memorial Medical Center and community hospitals HealthAlliance Hospital, Marlborough Hospital, and Wing Memorial Hospital, and affiliated hospital Harrington Hospital.
10/03/11 Since the news release of the patient death and this thread U Mass has removed the eICU link and no information about the eICU at that facility can be found on U Mass websit at all......a coincidence I find interesting.......
e-medicine is an attempt to validate a business, not a care, model. intensivists and staff are expected to prioritize on what the brain interprets as scenario based protocols. everyone remembers case studies, right? case studies do not have immediate and variable sequelae, tho'. behavioral psych is also pretty clear, the farther humans are removed from interpersonal action, there is less immediacy, accountability if you will, and communication is more frequently misinterpreted.
i'm not sure what umass' model is, but when i first read about e-med design, iirc, the ideal was 1 intensivist to 50 patients, rn-10/1, "aide"-3/1. no, i can't source those figures, but something concrete is out there on pubmed, webmedicine, etc.. patient/staff ratio has to be significantly higher, otherwise the facility could not justify the large front-end investment in the e-package.
its a bad idea, based on dollars. if we thought what happened in hospitals in nola was "bad", just wait until we have a grid failure effecting one of these facilities...
that is just crazy. that sounds nowhere near like an "extra set of eyes." it sounds like a very dangerous reduction in attention paid to that icu patient. i just cannot believe anyone can justify those kinds of ratios.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
e-medicine is an attempt to validate a business, not a care, model. intensivists and staff are expected to prioritize on what the brain interprets as scenario based protocols. everyone remembers case studies, right? case studies do not have immediate and variable sequelae, tho'. behavioral psych is also pretty clear, the farther humans are removed from interpersonal action, there is less immediacy, accountability if you will, and communication is more frequently misinterpreted.
i'm not sure what umass' model is, but when i first read about e-med design, iirc, the ideal was 1 intensivist to 50 patients, rn-10/1, "aide"-3/1. no, i can't source those figures, but something concrete is out there on pubmed, webmedicine, etc.. patient/staff ratio has to be significantly higher, otherwise the facility could not justify the large front-end investment in the e-package.
its a bad idea, based on dollars. if we thought what happened in hospitals in nola was "bad", just wait until we have a grid failure effecting one of these facilities...
agreed, this is a multi-hospital system.
eicu program
the umass memorial health care system offers anextra level of care through the eicu® program to patients admitted to intensive care units across our system, includingumass memorial medical center and community hospitals healthalliance hospital, marlborough hospital, and wing memorial hospital, and affiliated hospital harrington hospital.
and i know personally that umass itself........has seven icus and step downs to match all monitored by central monitoring system. i am curious, even if the battery was dead(the 2007 death after the eicu system was activated)....the question of who's minding the store still looms large and why are just the nurses to blame.
to address altra's statement that "this article, sept. 21, 2011, describes the recent patient death (the 60-year old male) ... as well as another patient death of a female patient related to a dead battery in her monitor.
and am i losing it ... ?
both this thread and the one under the nursing news forum reference the same one boston globe article of sept. 21. the article describes this patient as being a 60-year old male s/p tbi. it also describes the patient being given a dose of 5mg of ativan. at some point after that, the alarms signaled the patients respiratory arrest.
both articles talk of alarm fatigue.....a nurses problem versus a failure to recognize by their eicu professional "intensivists" as they state on their own website.......http://www.umassmemorial.org/systemip.cfm?id=4442
the eicu program's specially trained critical care physicians known as intensivists use voice, data and video technology to enhance the patient care provided by the icu bedside staff. this attention to detail helps identify a potential concern in a patients condition in the early stages, allowing icu staff to intervene with prompt treatment before conditions worsen.
how does alarm fatigue come into play when the patient is also remote monitored and still goes unnoticed......
the second patient death in four years involving “alarm fatigue’’ at umass memorial medical center has pushed the hospital to intensify efforts to prevent nurses from tuning out monitor warning alarms.
nurses exposed to a cacophony of beeps may no longer hear them or begin to ignore them, and that’s what appears to have happened in the latest case: a 60-year-old man died in an intensive care unit after alarms signaling a fast heart rate and potential breathing problems went unanswered for nearly an hour, according to state investigators who reviewed records at the hospital.
why isn't the eicu mentioned at all in the entire article and made it entirely a nursing issue......where was the intensivist then? i just feel nurses are the scapegoat for all hospitals ails. if eicus are the answer.....where did it fail, why isn't it (the eicu) mentioned in the article.....and why nurses are always the ones blamed.
i am still curious if anyone works at an eicu and how it actually works......:heartbeat
edit 10/03/11 all information regarding eicu has been removed from the u mass web site....interesting.
I don't think the EICU actually means they are monitoring the tele? Isn't it more that they have ICU Specialists avail remotely thru video conference if a crisis happens and they are alerted to it.
Our hospital did away with tele monitor techs years ago so you don't always found changes in rhythms right away. Low and behold I now hear that we are the only hospital in the system without tele monitors and all the rest still have them. At the time I think they wanted to get rid of techs because they needed more PCA's. Even now they have changed the HUC position to a HUC/PCA where you have to do both!
All the constant alarms beeping is one of the reasons I don't want to do ICU! It's frustrating and stressful enough with the alarms where I work now between call lights, bedchecks, tele monitors and dash's. Sometimes you just want to scream and I'm afraid I'm going to be deaf by the time I can retire! When we had tele techs we didn't have quite so much noise! I do think working 3 12-s makes it more tolerable than if I was there 4-5 days a week listening to all the noise.
It's well known all the alarms adds to your stress and raises your BP and of course damages your hearing. I wish they would come up with a better way to handle this. So many times the tele alarms are artifact and false readings and are very hard to correct. Sometimes I come on and someone has disabled them. I always turn them back on when I see this because it is obviously dangerous to just disable the alarms.
If all ICUs at all UMASS facilities are included in the E-ICU system and that system is automatically in place for all patients, then I agree that it is a valid question to ask about the E-ICU staff response or lack of response during the hour that the 60-year old male patient's resp/pulse ox alarm supposedly was going off.
I'm not crazy about this thread title -- the use of the word "killed" in reference to either the E-ICU system or the nurses.
Specializes in Infectious Disease, Neuro, Research.
I'm not crazy about this thread title -- the use of the word "killed" in reference to either the E-ICU system or the nurses.
I would agree on the nurses; on the EICU, I would argue that it is entirely appropriate. When you engage a system that behavioral psychology and learning theory tell you will lead to failure, you have either made a cost-benefit choice stating that a certain number of ("extra")deaths are acceptable, or you have ignored two fundamental sciences pertaining to the success of the chosen model.
EICU is not just telemetry, it is the full array(body temp, hr, b/p to weight), with accessible video feed for "assessment". the original idea was to decrease the number of intesisvists required to maintain an (or multiple) ICs. Aides would be assigned to do the bed-n-breakfast thing, and to verify (first-line) s/s of distress. Of course, a decreased number of RNs would be needed because everything they needed to know would be available in the monitor array. I ASS-U-ME that the code model is for the aides and 1 RN to initiate, and have a responding code team take over.
The obvious deficit is the incredible huge fantastic mountainous number of false "positives" in the alarm system. For remote medicine to work, the E-gear has to be pretty well a literal 99% accurate.
Consider your kids (or husbands, in some cases:D) playing video games. If Call of Duty was 80% accurate in transmitting the players intentions to the game scenario, the player would die in exponents of 20%, because errors compound and increase the "fail" by orders of magnitude. Morbidity and mortality are no longer solely a function of partient viability and appropriate intervention, but are now also drive by failures of the electronic system (a third variable, with its own elements).
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
If all ICUs at all UMASS facilities are included in the E-ICU system and that system is automatically in place for all patients, then I agree that it is a valid question to ask about the E-ICU staff response or lack of response during the hour that the 60-year old male patient's resp/pulse ox alarm supposedly was going off.
I'm not crazy about this thread title -- the use of the word "killed" in reference to either the E-ICU system or the nurses.
Ok .....The word killed was to grab atention....my bad . I'll modify it if I can.....some 109 patient beds are monitored 24/7. I interviewed for a position and it gave me the creeps.
They talk about the Tele-treatment Monitoring from afar, 'eICUs' fill medical gap in this article
The emergence of eICUs shows that so-called "telemedicine" has reached a point where specialists trust it enough to make real-time treatment decisions for the sickest patients.
"This is a technology that enables us to practice better medicine," said Wendy Everett, president of the New England Healthcare Institute, a nonprofit research organization in Cambridge that wants to expand eICUs across the state and plans to study whether they improve survival rates for patients and reduce medical costs.
I have ambulation issues and went on an interview once. I thought "Hey I can sit and look at monitors all day and let someone know if something looks bad....I've been doing this for 32 years..." and I left there creeped out. they didn't hire me of course because I use a wheelchair now....but what ever.
Specializes in Infectious Disease, Neuro, Research.
"This is a technology that enables us to practice better medicine," said Wendy Everett, president of the New England Healthcare Institute, a nonprofit research organization in Cambridge that wants to expand eICUs across the state and plans to study whether they improve survival rates for patients and reduce medical costs.
..
So speaks a fool or a political demagogue. Let's take something we're all familiar with, fluid replacement therapy.
For any given intervention (in this case FRT) there are two sequential possibilities-positive or negative, and each is weighted with concurrent risks or benefits.
With FRT, the Positives are straightforward: volemic homeostasis, normalized electrolytes, normalized cardiac load/output.
Negatives: electrolyte imbalance, r/hypo-/hypervolemia, cardiac arrythmia r/lyte imbalance, cardiac overload, etc., etc., with each of these haveing a few more related sequelae.
Risk management, and validation of an intervental theory, requires that the positives outweigh the negatives. Using FRT again, if we use a pump, instead of a plain ol' drip bag, we've introduced a change in the equation. The number and efficacy of the Positives change little (though notably, in stability of treatment). The negatives climb dramatically however, as we have added a third variable (the pump) and all patient variable are now dependent on the pump's "success" algorythm. The pump, to be successful, depends on staff training, power supply, mecahnical/electrical wear/breakdown, programming failure, etc., etc..
The psychology of alarm response and stress innoculation is well documented, since the 1940s, in fighter pilots. For alarms to be effective in an intensive setting, they must be directly event related (very few false positives), they must be novel (staff cannot sit for hours, monitoring. Pilots do combat air patrol for between 2 and 4 hours, typically), and the staff must be consistently highly trained (i.e., day-to-day routine ain't it).
If I were a legal consultant, I'd be doing a lit search, and getting ready to go after UMass like a pitbull after a running, screaming 10 year old in rare steak shorts.
Here's a link to the Tele-Med Study:http://www.nehi.net/publications/49/critical_care_critical_choices_the_case_for_teleicus_in_intensive_care
Specializes in Infectious Disease, Neuro, Research.
(cont.) I'm skimming, so I may be jumping the gun here, but what I don't like:
A decrease of 10 percent in severity-adjusted ICU mortality rates and no increase in hospital mortality rates of patients discharged from the ICU and transferred to the hospital floor.
Well, that's great, but is it statistically significantly higher than facilities with intensivists on staff, and is this a consistent trend, and what is the effect of novelty and performance bias?
Equally, their report notes a 15-60% reduction in mortality, relating to the presence of intensivists in the IC(as recognized by multiple previous studies). They do not note whether the 13% mortality reduction they saw in the survey sites also included the introduction of intensivists into (via telemed) facilities that did not have them previously- they are adroitly avoiding a potential difference in interpersonal vs. tele-assessment by the physcian.
At the same time, they note an increase in severity of IC patients (APACHEIII scores), which in itself increases staff "arousal", i.e., the more critical the patient, the more watchful humans are. The key question being, without the immediacy of presence, and with false-positive alarming, what is the effect on the staff longitudinal level of alertness?
I'm sorry, this is happy-horsehit, validating a cost containment model.
On page 39, you'll see that two groups comprise 92% of the tele-med program cost: non-clinical staff(20%) and MD/NP/PAs (72%). Either RNs aren't in the budget- meaning there are damn few of them available, or they are listed under non-clinical staff- still meaning there are damn few on a 24/7 schedule, if the total non-clin budget is $630,000.
the eicu program's specially trained critical care physicians known as 
. I'll modify it if I can.....some 109 patient beds are monitored 24/7. I interviewed for a position and it gave me the creeps.
Esme12, ASN, BSN, RN
20,908 Posts
It didn't but all their ICU's are monitored by EICU's