Find out how to reduce Code Blue events
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Find out how to reduce Code Blue events
- 1. Leyton Stevens Director of Healthcare BES Rehab Ltd
- 2. Common Challenges Clinical: • Increased acuity & age • Deteriorating patients with inadequate monitoring • Pressure ulcers • Patient falls • No increase in staff Financial • ICU length of stay • Increased demand for Telemetry & ICU beds (overused?) • Reimbursement cuts on adverse events & readmitted patients Managerial • Staff accountability & critical thinking • Inadequate management tools • Alarm fatigue • Patient discharge and readmission prevention Multi-faceted Challenges in Healthcare
- 3. • Cost of treating pressure ulcers: £2.1bn annually1 NHS Statistics 1. Bennett, G et al (2004) The Cost of Pressure Ulcers in the UK 2. National Institute for Health and Care Excellence (2013) Falls: the assessment and prevention of falls in older people 3. Tian, Y et al (2013) Exploring the system wide cost of falls in Torbay 4. NHS Confederation (2016) Key Statistics on the NHS 5. Data.Gov.UK (2015) Department of Health: NHS Hospital Stay ‘Harmsfree’campaign • Cost of falls to the NHS: £2bn annually2 • Falls in hospitals accounted for 324,000 (26%) of all patient safety incidents3 • Patient deterioration • Average length of stay in hospital: 7 days4 with per bed day cost £4005
- 4. What is EarlySense? Around the clock care, bed and chair sensors
- 5. Contact-Free Sensor What is EarlySense? Heart Rate Respiratory rate Motion
- 6. The EarlySense Chair Sensor “Since we started using the chair sensor we have had zero patient falls from chairs...” (August 2014) S. Hughes, RN. Director of Medical Surgical Coffee Regional Medical Center, Douglas, GA
- 7. 87% EarlySense Benefits Reduction in Code Blue events Reduction in Pressure Ulcers64% Reduction in Falls44% Reduction in Length of Stay9% Based on a 7,643 Patient Clinical Trial
- 8. What are the costs? Falls • Pearson, K.B. & Coburn, A.F. Evidence-based Falls Prevention in Critical Access Hospitals. 2011. • Australian Commission on Safety and Quality in Healthcare (ACSQHC). Preventing falls and harm from falls in older people: best practice guidelines for Australian community care. Canberra (ACT): Commonwealth of Australia, 2009.
- 9. Reducing the incidence of falls
- 10. 87% EarlySense Benefits Reduction in Code Blue events Reduction in Pressure Ulcers64% Reduction in Falls44% Reduction in Length of Stay9% Based on a 7,643 Patient Clinical Trial Reduction in Pressure Ulcer Incidence
- 11. What are the costs? Reduction in Pressure Ulcer Incidence • Cost of litigation £180,000 per case on average • £2 billion pa • 4% of total NHS budget • Prevalence of Hospital Acquired Pressure Ulcers is 5% in acute care settings1 • Treatment costs: up to £40,000 an ulcer 1 Lyder et al. Hospital-acquired pressure ulcers: results from the national medicare patient safety monitoring system study. J Am Geriatr Soc. 2012 Sep;60(9):1603-8.
- 12. What are the costs? Reduction in Pressure Ulcer Incidence 1 Lyder et al. Hospital-acquired pressure ulcers: results from the national medicare patient safety monitoring system study. J Am Geriatr Soc. 2012 Sep;60(9):1603-8. Pressure ulcers are considered to be preventable; and Hospital Acquired Pressure Ulcers (HAPU)are commonly perceived as an indicator of quality of care • Stay in hospital longer - 136% higher average length of stay • More likely to be readmitted within 30 days - 33% more • More likely to die during their hospitalisation: 2.81 times (181% more) Patients with HAPU compared to patients without HAPU are1
- 13. Reducing the incidence of Pressure Ulcers
- 14. 87% EarlySense Benefits Reduction in Code Blue events Reduction in Pressure Ulcers64% Reduction in Falls44% Reduction in Length of Stay9% Based on a 7,643 Patient Clinical Trial Reduction in Pressure Ulcer Incidence
- 15. Vitals tracking Critical events are estimated to occur in up to 17% of patient admissions1 1. The Joint Commission Guidelines 2. Schein R.M. et al, Chest 1990; 98: 1388-92. 3. Franklin C. & Mathew J. Critical care medicine 22, 244-247 4. Young MP et al, J Gen Intern Med. 2003; 18: 77-83 5. Chaboyer W et al (Amer J of Critical Care. 2008;17) 6. Churpek, M et al. (Chest: 2012;141) Significant number of critical events are preceded by warning signs 6 to 8 hours prior to the event1 • Heart and Respiratory Rates are most valuable early detectors of deterioration risk5,6 • Responding to early warning signs reduces mortality by 75% and cost by 40%4 • 66% of patients have abnormal symptoms 6 hours before cardiac arrest and the doctor is informed only in 25% of these patients3 • 70% of patients have respiratory problems within 8 hours prior to circulatory arrest2
- 16. Cardiac Arrhythmia – Case Study About the Patient: A 55 year old female with metastatic Lung Cancer. History of Pneumonia, Embolus and Stroke. Hospitalised for over a month awaiting rehab placement. EarlySense Indication: 7:30 AM: High HR alerts (180’s BPM) Assessment: Complaints of palpitations and light headedness. The patient had not reported this, thinking it a symptom of her condition. An ECG was undertaken and an Atrial flutter identified. Response: Suitable medication was prescribed Outcome: The patient returned to normal sinus rhythm. High Heart Rate Alert Leading to Identification of Atrial Flutter and return to Normal Sinus Rhythm Med-Surg Dep., MA, USA Lines Icons Respiratory Rate Heart Rate High Heart Rate Alert Multiple Alerts
- 17. Paperless Recording of Data along with Trend Analysis
- 18. EarlySense Reduction in Alarm Fatigue In comparison with other monitoring solutions designed and intended for the acute care environment, EarlySense provides very low alarm rates: 1. Zimlichman et al. Evaluation of EverOn as a Tool to Detect Deteriorations 2. LifeSync: LifeSync Wireless ECG System… Increases ECG Alarm Accuracy 3. Malviya, S. et al., A & A June 2000 vol. 90 no. 6 1336-1340 Monitoring Technology Alarms per 100 hours of monitoring False alarms per 100 hours of monitoring Alarms per nurse per shift False alarms per nurse per shift EarlySense1 2.8 1.2 1.7 .07 Telemetry2 151.8 82.0 91.1 49.2 Oximetry3 200.0 118.0 120.0 72.0
- 19. 1. Allman RM, eat al. Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Adv Wound Care. 1999. 2. Milbrandt EB, et al. Growth of intensive care unit resource use and its estimated cost in Medicare. Crit Care Med. 2008. Health Care Utilization Project (HCUP), Nationwide Inpatient Sample (NIS), Agency for Healthcare Research and Quality, 2008 Model Analysis Consideration Savings Per Patient Admission Annual Savings 1. Base Case Total cost of intervention effects $710 $1,701,600 1. Conservative Includes only direct variable cost Component of final day of LOS $224 $537,400 Slight, SP et al, Society of General Internal Medicine. 2013 Assuming 33 beds, 2,500 Patients per Unit per Year Costs Associated for Calculation: Pressure Ulcer = $15,229 per case¹ Medical-surgical Hospitalization = $1,448 per Day² ICU Hospitalization = $2,575 per Day²
- 20. EarlySense cost comparison With EarlySense (33 beds implementation) Without EarlySense (90 beds)
- 22. Any Questions? If you would like to know more about delivering improved outcomes using EarlySense Please pay us a visit: BES Rehab Ltd on Stand 128
Hinweis der Redaktion
- “Fine words” say the sceptics, “but where’s the money? With all the pressures we face, it is simply not affordable to raise safety standards in way you ask”. Nothing could be more wrong. Wrong ethically, because it can never be right to condone a system in which patients suffer harm unnecessarily. But wrong economically too. Because our starting point must be to recognise that unsafe care ends up being more - not less - expensive, particularly if you look at the costs to the healthcare system as a whole. Every year the NHS spends around £1.3 bn on litigation claims, money that could and should be spent on frontline staff. At a hospital level the figures are even more startling: in recent years North Cumbria paid £3.6m to just one individual. Bromley paid £7m to another. Tameside paid a staggering £44m in compensation over just four years. Money matters, of course, but look at the impact on staff – and above all patients and their families. There can be no greater breach of the trust between clinician and patient than when a patient is harmed unnecessarily. There may be a profit motive in no-fault manufacturing but there is a moral motive for zero-harm healthcare. And we should welcome that – because that is what healthcare is: the privilege of helping human beings at their most vulnerableAnd the effect on frontline healthcare workers is profound if unsafe care is not checked. Not only does it take up huge amounts of clinical time when mistakes have to be corrected and hospital stays prolonged. It has – as I have seen for myself - a devastating effect on staff morale and self-confidence. Avoidable harm does more than damage institutional reputations - it is a violation of the values and ideals that unite everyone in the provision of health. Financially, reputationally and morally unsafe care carries a price – a price we cannot and should not pay.
- Raising awareness, improving education and adopting more appropriate preventative interventions are all necessary to achieve our objectives. NHS Safety Thermometer The NHS Safety Thermometer is a local improvement tool for measuring, monitoring and analysing patient harms and 'harm free' care. Supporting 'harm free' care The NHS Safety Thermometer provides a quick and simple method for surveying patient harms and analysing results so that you can measure and monitor local improvement and harm free care (external) (Opens in a new window) over time. The campaign is focused on SSKIN; a five step model for pressure ulcer prevention: Surface: make sure your patients have the right support Skin inspection: early inspection means early detection. Show patients & carers what to look for Keep your patients moving Incontinence / moisture: your patients need to be clean and dry Nutrition / hydration: help patients have the right diet and plenty of fluids
- A discreet, highly sensitive contact free sensor is placed under the mattress
- Falls reduction Impact of Nursing Safety Initiatives on Patient Outcomes Florida, Tampa. FONE Poster http://www.earlysense.com/wp-content/uploads/2013/08/FONE-Poster-Nov-2013.pdf 28.01.2016 PU reduction Brown, HV & Zimlichman, E (2010) Improved Outcomes and Reduced Costs with Contact-free Continuous Patient Monitoring on a Medical-Surgical Hospital Unit EarlySense.com http://www.earlysense.com/wp-content/uploads/2013/08/White_Paper_Patient-safety_Dec8_2010.pdf 28.01.2016 Resuscitation reduction Brown, HV et al (2013) Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial Am J Med127, 226-232 Overall Length of of stay Brown, HV et al, The American Journal of Medicine, In Press. http://www.earlysense.com/faq/
- Anyone can have a fall, but older people are more vulnerable and likely to fall, especially if they have a long-term health condition. Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year. The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall. Falls are estimated to cost the NHS more than £2.3 billion per year (College of Optometrists/British Geriatrics Society, 2011). Therefore falling has an impact on quality of life, health and healthcare costs.
- Falls reduction Impact of Nursing Safety Initiatives on Patient Outcomes Florida, Tampa. FONE Poster http://www.earlysense.com/wp-content/uploads/2013/08/FONE-Poster-Nov-2013.pdf 28.01.2016 PU reduction Brown, HV & Zimlichman, E (2010) Improved Outcomes and Reduced Costs with Contact-free Continuous Patient Monitoring on a Medical-Surgical Hospital Unit EarlySense.com http://www.earlysense.com/wp-content/uploads/2013/08/White_Paper_Patient-safety_Dec8_2010.pdf 28.01.2016 Resuscitation reduction Brown, HV et al (2013) Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial Am J Med127, 226-232 Overall Length of of stay Brown, HV et al, The American Journal of Medicine, In Press. http://www.earlysense.com/faq/
- Falls reduction Impact of Nursing Safety Initiatives on Patient Outcomes Florida, Tampa. FONE Poster http://www.earlysense.com/wp-content/uploads/2013/08/FONE-Poster-Nov-2013.pdf 28.01.2016 PU reduction Brown, HV & Zimlichman, E (2010) Improved Outcomes and Reduced Costs with Contact-free Continuous Patient Monitoring on a Medical-Surgical Hospital Unit EarlySense.com http://www.earlysense.com/wp-content/uploads/2013/08/White_Paper_Patient-safety_Dec8_2010.pdf 28.01.2016 Resuscitation reduction Brown, HV et al (2013) Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial Am J Med127, 226-232 Overall Length of of stay Brown, HV et al, The American Journal of Medicine, In Press. http://www.earlysense.com/faq/
- Analysis of 56 deaths reported to the National Patient Safety Agency over a one year period identified that 11 Per cent were as a result of not recognised or acted upon! Clinical deterioration can happen at any point in a patient’s illness, or care process, but patients are particularly vulnerable following an emergency admission to hospital, after surgery and during recovery from a critical illness. Many patients who suffer cardiopulmonary arrests show signs of deterioration during the hours before the arrest1 and it has been estimated that approximately 23,000 in-hospital cardiac arrests in the UK could be avoided each year with better care2. no observations made for a prolonged period and therefore changes in a patient’s vital signs not detected; Diane.rodger@basf.com