Combating the Clinical Labor Shortage Utilizing Real-Time Clinical Analytics, Remote Patient Monitoring and Virtual ICUs
Contributors: Al Berning, Chief Executive Officer at Ambient Clinical Analytics - Megan Sternke, Digital Marketing Strategist at Magnetic North - Tim Kuebelbeck, Chief Customer Officer at Ambient Clinical Analytics
American nurses and healthcare workers have been the feature of news stories throughout the COVID-19 pandemic. Some of these articles highlight their extraordinary dedication to their job despite unprecedented conditions, while others share stories of the extreme strain they are experiencing in their roles. The pandemic has been a catalyst of struggle for healthcare workers, including burnout, limited resources, and labor shortage.
The data flowing out of health systems on the effects of the healthcare labor shortage is frightening. Almost daily there are news articles about the escalating hospital costs and psychological damage to healthcare workers, never mind the pain and suffering it is causing our patients and their families. The healthcare labor shortage needs to be addressed quickly as it is already a major national crisis and is projected to escalate and get much worse over the next few years.
From world wars and economic recessions, there have been many causes of nursing shortages throughout history. However, the magnitude of the current nursing shortage is greater than ever before in this country. During the pandemic, more than 80% of hospitals have reported an increase in nurse turnover1 . In a survey of more than 20,000 nurses conducted in 2020, 18% intended to resign, 50% responded that work was negatively impacting their health, and 47% reported that insufficient staffing contributed to their desire to leave the profession2 . This is a nightmare for hospitals, as staffing shortages have been associated with both increased costs and decreased patient safety.
A clear example of this is a survey of 138 facilities covering more than 120,000 nurses. The survey found that the average cost of turnover ranged from $37,400 to $58,400 per nurse3 . Even more disturbing, another study of almost 200,000 patients across 43 hospital units found a significant association between increased patient mortality and nurse staffing below target levels. More specifically, In the February 2014 issue of the Lancet, Linda Aiken and colleagues published findings from a study conducted in European hospitals, which found that an increase in a nurses’ workload by one patient increased the likelihood of dying within 30 days of admission by 7%.4
These should be alarming numbers for any hospital. The cost of a staffing shortage is far too great, and it is not looking to improve anytime soon. Given the growing demand for healthcare services, reports project that 1.2 million new registered nurses (RNs) will be needed by 2030 to address the current shortage.5 However, the combination of limited faculty in training programs and universities, the upcoming retirement of a large part of the workforce, and the association of burnout to the profession are going to make that goal of new nurses very difficult to hit. As the pandemic continues, health systems will continue to face limitations and resource shortages for everything from equipment, supplies, and beds to doctors and administrative staff. However, the shortage of qualified nurses due to burnout will be the most significant challenge of all.
Today’s EHR solutions are not designed for clinical care delivery especially for telemedicine or virtual-ICU’s, instead they are built and based on previously existing hospital billing systems. These hospital billing systems have been adapted as a nested spreadsheet with clinical data to attempt to deliver clinical care. This model has created multiple data areas that doctors and nurses need to search to find relevant clinical data and are a source of intense pain and anguish for healthcare workers. EHR’s have also been the ire of many articles over the past few years including Why Physicians Hate Their Computers and Death by 1,000 Clicks: Where Electronic Health Records Went Wrong. A more recent article in The Atlantic illustrates these points very clearly. They state, “Health-care workers aren't quitting because they can’t handle their jobs. They’re quitting because they can’t handle being unable to do their jobs. Even before COVID-19, many of them struggled to bridge the gap between the noble ideals of their profession and the realities of its business. The pandemic simply pushed them past the limits of that compromise.”6 Clearly these EHR solutions are the major contributor in healthcare workers inability to do their jobs and continues to create undue stress on our healthcare heroes.
What can hospitals do to alleviate the staffing shortage?
While there are initiatives underway to support the education of new nurses and incentives for entering the profession (such as loan forgiveness and health system partnerships), that doesn’t leave much to the control of hospitals and health systems7 . While these organizations can research incentives to attract and retain top nursing talent, one major aspect that cannot be overlooked is upcoming technology advancements. Health systems need to research tools that make the jobs of their current staff easier. The benefits are endless if they can effectively alleviate the workload of each worker. This includes reductions in mortality, cost savings, an increase in quality of care, a decrease in nurse turnover and burnout, and much more. A few major technologies that health systems are turning to is the use of bedside clinical analytics tools that reduce the clicks and manual computer effort required to care for patients, remote patient monitoring, and the virtual-ICU.
Real-Time Clinical Analytics Applications
One specific technology is a completely portable real-time clinical analytics solution that is Software as a Medical Device (SaMD) and FDA cleared. Solutions like this allow hospitalists or Intensivist’s to provide complex, comprehensive, and collaborative virtual-ICU or virtual acute care from anywhere using just a laptop. In today’s virtual-ICU or telemedicine acute care environment, a hospitalist or intensivist doesn’t have access to all EHR data integrated into a single view on a clinical analytics platform. In addition, if that intensivist or hospitalist is monitoring multiple hospitals, she/he certainly will have to bounce in and out of multiple EHRs as well as their tele-ICU solution. Portable real-time clinical analytics solutions that have full EHR clinical data integration allows the physician or nurse to skip having to flip back and forth between the virtual-ICU system and multiple EHR’s. Having all the data in one place combined with AI and Machine Learning algorithms to help assess and treat patients allows physicians and nurses the ability to monitor many more patients than they can today, and they can do it from anywhere, rendering today’s expensive hub style tele-ICU command centers much less important and over time likely irrelevant.
The ability to have physicians and nurses utilize remote patient monitoring from anywhere in any acute care setting including a virtual-ICU, will drive massive efficiency and help ease the current and escalating clinical labor shortage in two ways. One, it will reduce the stress placed on nurses and physicians (or any provider for that matter) by poor technology designed for billing rather than clinical care. Second, the efficiency from these systems will allow existing clinicians the ability to effectively care for much larger numbers of patients without creating fatigue and stress. This is especially important in rural areas where physician shortages are growing more rapidly and putting people who live in remote areas at major risk of not having the clinical expertise available when needed. A recent article pointed out that, “Rural areas could experience more problems because of the physician shortage than urban areas. According to current data for Healthcare Professional Shortage Areas (HPSAs), mostly-rural states such as Utah, Vermont, Tennessee, as well as remote territories like Guam and the Northern Mariana Islands, have the highest shortages in medical professionals per capita.”8
Completely portable real-time virtual-ICU and virtual acute care solutions that are FDA cleared allows Intensivists and Hospitalists to be part of a Clinical Mesh Network instead of having to drive or travel to a Hub. Combined with analytics that help drive a diagnosis and the care bundle, a physician can sit anywhere and care for more patients in (even without a $20K home setup) and do it all from within one solution. The virtual-ICU market is demanding not just 24/7 Clinical Command Centers but Clinical Mesh Networks that provide for Ad-Hoc and On-Demand ICU care or home care.
The AWARE Sepsis DART platform uses AI/ML based algorithms to significantly reduce the amount of time required to assess and treat patients. In addition, peer-reviewed research shows it reduces errors by up to 50% thereby also reducing a primary driver of clinician and nursing time, fixing errors9 . The AWARE Sepsis DART platform was developed by combining Health IT with human factor ergonomics and System Engineering to design a system that extracts high value data from the EMR and presents it to the clinical and nursing teams in patient centric information packages10 .
By using AI based algorithms or rules the clinical and nursing teams can eliminate the thousands of clicks required to manually extract data from the EMR as highlighted in the aforementioned article “Death by 1000 Clicks” and save on average 25% of the time it takes to assess, diagnose, and deliver care to a patient. These types of AI based algorithms have been successfully used in our personal lives and many industries to automatically extract and present the most relevant information for a given task.
Known for its industry leading DART™ sepsis solutions, agnostic solutions like Ambient’s AWARE™ (virtual-ICU) saves lives and provides all the needed EHR data in one solution. Delivering true virtual-ICU and telemedicine acute care (regardless of a patient’s location) requires having lightweight solutions that are platform independent and camera agnostic. True telemedicine care in all settings of acute care from the ICU to skilled or long-term nursing facilities, and even into the home is the ultimate goal to help alleviate the labor crisis for nurses and medical doctors.
Tele-ICU and Remote Patient Monitoring
Traditional telehealth and virtual ICU’s have surged across the country in the wake of COVID-19, but traditional telehealth solutions only solve a portion of the problem. Virtual-ICU software requires FDA clearance for active patient monitoring. A complete platform for a Virtual ICU requires access to traditional telehealth, integrated with additional clinical analytics and data visualization. Integrated virtual ICU platforms allow physicians and nurses to effectively monitor all hospital beds, in addition to the ICU beds, and will help track patient deterioration using automatic APACHE IV, SOFA, Sepsis, & Ventilator Induced Lung Injury (VILI) types of scoring and sniffers. This is critical during the COVID-19 pandemic. Integrating early warnings and changes in a patient’s condition with traditional telehealth software, along with the ability to track and monitor patients from admit to discharge, make virtual ICU platforms ideal for dealing with the current nursing labor shortage.
Virtual ICU platforms drive situational awareness by providing a health system’s clinical staff the ability to utilize remote patient monitoring and manage every bed in the health system like it is an ICU bed. Using point of care access to vital process-of-care information and real-time analytics allows health systems to increase their ability to handle ICU surges and improve the safety for both the clinicians and the patients.
It is evident that despite improvements in modern tele-ICU’s, most current approaches to virtual ICU care and remote patient monitoring fall short of providing the data visualization and clinical decision support tools required to effectively care for critically ill patients. Over the years and especially through this pandemic, we have learned that AWARE's innovative virtual ICU UX design focuses on delivering those requirements while reducing information overload and making it possible to prioritize clinically important information. AWARE’s Remote Patient Monitoring implementations have been associated with marked improvement in clinical outcomes. “Adjusted for illness severity, the odds for hospital mortality of critically ill patients treated after AWARE implementation were reduced by half (odds ratio 0.45, 95% confidence interval 0.30 to 0.70). In addition, the length of ICU stay decreased by 50%, length of hospital stays by 37%, and total charges for hospital stay by 30% ($43,745 per hospital admission).”11
Other key outcomes that have been measured include:
Provider Level: cognitive load, safety culture, team communication, satisfaction, technology usage.
System Level: Processes of care targets will be identified with local practice but may include items such as the use of non-invasive and low tidal volume modes of ventilation, judicious fluid resuscitation and shock reversal, restricted blood product use, DVT prophylaxis, central device removal, goals of care discussion, and sepsis bundle of care compliance.
Patient Level: ICU and overall hospital mortality (unadjusted and severity of illness adjusted), ICU and overall hospital length of stay, ventilator-free days, discharge location, and better communications to families.
Unit Level: Development of numerous unit-based algorithms covering all aspects of critical care.
These are key outcomes that every health system should strive for as they select a virtual ICU solution. Meeting the nurses and physician requirements for your virtual ICU must also take into consideration remote patient monitoring for the larger general inpatient, ED, and any other beds outside of your critical care units. Ignoring the patient population outside of the critical care areas typically ends in a selection of a very narrow virtual ICU solution, and long-term ultimately results in hospitals and health systems having to purchase expensive duplicative solutions and IT having to manage multiple solutions.
Understanding these factors will help guide your team to make an informed and appropriate selection of an enterprise platform that best improves patient care, reduces clinical staff burnout, while meeting your hospital and health system needs. Although there are a multitude of elements playing into the labor shortage within health systems, adding remote patient monitoring and tele-ICU solutions to your tool kits will be vital to combating the ongoing labor shortage.
About Ambient Clinical Analytics
AWARE™ Critical Care
Ambient has achieved FDA Class II Clearance, CE Marking, and ISO 13485:2016 Certification on the AWARE™ platform. AWARE™ provides remote patient monitoring and predictive analytics combined with novel clinical decision support tools that reduce provider fatigue, errors, and saves lives. Created by clinicians for clinicians, AWARE™ delivers real-time virtual-ICU surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
In additiuon to providing virtual-ICU camera functionality, AWARE’s (Ambient Warning and Response Evaluation) virtual-ICU solution is designed to provide bedside and remote patient monitoring from anywhere using data visualization and clinical analytics. The AWARE™ Multi-Patient Viewer (MPV) and Single-Patient Viewer (SPV) allows all nurses and physicians to view a patient through the eyes of a intensivists. Critical care requires turning massive amounts of raw data into actionable knowledge and many of the electronic tools at your disposal make this much more complicated than necessary.
This complication, commonly known as information overload, frustrates clinicians and exposes patients to diagnostic errors and therapeutic harm. AWARE™ is different, it was built by intensivists with Mayo Clinic using principles of human factors engineering, gathering the data that’s important to critical care teams and displaying it in a way that minimizes cognitive load. AWARE™ is the gold standard for how smart clinical analytics and data visualization can improve communication, efficiency, situational awareness, and safety. Unlike any other system, AWARE™ shows you what you need to see, at the point of care and in virtual ICU settings, organized the way an intensivist approaches their patients’ data.
AWARE Clinical Control Tower™ is a solution designed to provide a virtual ICU or acute care anywhere for both AWARE™ and Sepsis DART™ with centralized or decentralized remote patient monitoring and collaboration for physicians and nurses. AWARE™ and Sepsis DART™ capabilities are delivered to all locations in a standardized format, eliminating EMR differences. Clinical Control Tower™ provides distributed tele-health, virtual-ICU and remote patient monitoring within your system and with any contracted facilities.
Whether deployed in an ICU or as a virtual ICU solution, the AWARE™ enterprise class family of solutions including Sepsis DART, AWARE Critical Care, and Clinical Control Tower all help you approach your patients in a more effective, informed, and organized fashion while decreasing provider fatigue, reducing errors, and saving lives. Created by clinicians for clinicians, AWARE™ delivers real-time surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
The combination of effective predictive analytics and advanced clinical decision support tools helps to reduces errors, improve patient outcomes, reduce the cost of care, and deliver best-care practices for ICUs and other inpatient care areas. AWARE’s predictive analytics system provides a “smart view” via data visualization of Electronic Health Record data that reduces the risk of medical errors and improves patient outcomes with high reliability healthcare. It works with your EMR and bedside monitors to present only relevant information for care delivery. This minimizes information overload, which is a leading cause of medical errors, and results in a lower cost of care. By facilitating quick access to patients’ information at the point of care and in remote patient monitoring centers using AWARE’s Clinical Control Tower™, Ambient aids interventional decision-making and is proven to reduce the incidence of cognitive errors by 50%.
For more detailed information about Ambient Clinical Analytics please contact tim.kuebelbeck@ambientclinical.com.
About Ambient Clinical Analytics - Ambient is an industry leader supporting leading healthcare systems and has done so since its founding in 2013. Our solutions are designed by clinicians to be easy-to-use by every caregiver in your organization and are configured to be up and running rapidly. We are trusted by a community of high-performing healthcare providers across the United States. Our solutions are powerful real-time point-of-care and remote healthcare platforms designed to deliver life-saving analytics and solutions using data visualization, communication, analytics and rules based clinical decision support.
Ambient’s AWARE™ and Sepsis DART™ solutions are exceptionally secure, high-performance, FDA Class II approved and CE Marking certified Software as a Medical Device (SaMD) platforms. Ambient’s Sepsis DART™ product has been accepted into the Patient Safety Movement’s Actionable Patient Safety Solutions (APSS) #9 for Sepsis. Ambient has achieved ISO 13485:2016 certification, an internationally recognized quality standard specific to the medical device industry. The ISO 13485 standard sets out the requirements for a quality management system specific to the medical device industry. Ambient is also deploying the AWARE™ family of solutions, to help manage COVID-19. Ambient’s Virtual-ICU platforms are ideal for any acute patient care setting including the virtual-ICU. For more information, visit https://ambientclinical.com.
1“Study: 186% Pandemic Spike in Nurse Demand Worsens Turnover and Stress.” Incredible Health, 10 Aug. 2021, https://www.incrediblehealth.com/blog/study-covid-19-anniversary-nurse-impact/. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/year-one-covid-19-impact-assessment-survey/
2“Year One COVID-19 Impact Assessment Survey.” Nursing World, ANA Enterprise, Feb. 2021, https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/year-one-covid-19-impact-assessment-survey/.
3“The High Cost of Nurse Turnover.” University of New Mexico, 30 Nov. 2016, https://rnbsnonline.unm.edu/articles/high-cost-of-nurse-turnover.aspx. Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med. 2011 Mar 17;364(11):1037-45. doi: 10.1056/NEJMsa1001025. PMID: 21410372.
4Terri Williams, “1.2 Million More Nurses Needed by 2030 to Meet U.S. Demand,” Good Call: https://www.goodcall.com/news/1-2-million-more-nurses-needed-by-2030-to-meet-u-s-demand-09308/
5Young LK;Adams JL;Lundeen S;May KA;Smith R;Wendt LE; “Nurses for Wisconsin: A Collaborative Initiative to Enhance the Nurse Educator Workforce.” Journal of Professional Nursing : Official Journal of the American Association of Colleges of Nursing, U.S. National Library of Medicine, 2016, https://pubmed.ncbi.nlm.nih.gov/27424929/.
6Young, ED, Why Healthcare Workers Are Quitting in Droves, The Atlantic, https://www.theatlantic.com/health/archive/2021/11/the-mass-exodus-of-americas-health-care-workers/620713/ , Nov 16, 2021
7Olchanski, N., et al., Can a Novel ICU Data Display Positively Affect Patient Outcomes and Save Lives? J Med Syst, 2017. 41(11): p. 171.
8Duquesne University School of Nursing, The Shortage of Healthcare Workers in the U.S. https://onlinenursing.duq.edu/post-master-certificates/shortage-of-healthcare-workers/ , Oct. 5, 2021
9Pickering, et al., Novel Representation of Clinical Information in the ICU, Applied Clinical Informatics, 2010
10Pickering, Litell, et al, Clinical review: The hospital of the future – building intelligent environments to facilitate safe and effective acute care delivery, Critical Care, 2012
11Olchanski, N., et al., Can a Novel ICU Data Display Positively Affect Patient Outcomes and Save Lives? J Med Syst, 2017. 41(11): p. 171.
American nurses and healthcare workers have been the feature of news stories throughout the COVID-19 pandemic. Some of these articles highlight their extraordinary dedication to their job despite unprecedented conditions, while others share stories of the extreme strain they are experiencing in their roles. The pandemic has been a catalyst of struggle for healthcare workers, including burnout, limited resources, and labor shortage.
The data flowing out of health systems on the effects of the healthcare labor shortage is frightening. Almost daily there are news articles about the escalating hospital costs and psychological damage to healthcare workers, never mind the pain and suffering it is causing our patients and their families. The healthcare labor shortage needs to be addressed quickly as it is already a major national crisis and is projected to escalate and get much worse over the next few years.
From world wars and economic recessions, there have been many causes of nursing shortages throughout history. However, the magnitude of the current nursing shortage is greater than ever before in this country. During the pandemic, more than 80% of hospitals have reported an increase in nurse turnover1 . In a survey of more than 20,000 nurses conducted in 2020, 18% intended to resign, 50% responded that work was negatively impacting their health, and 47% reported that insufficient staffing contributed to their desire to leave the profession2 . This is a nightmare for hospitals, as staffing shortages have been associated with both increased costs and decreased patient safety.
A clear example of this is a survey of 138 facilities covering more than 120,000 nurses. The survey found that the average cost of turnover ranged from $37,400 to $58,400 per nurse3 . Even more disturbing, another study of almost 200,000 patients across 43 hospital units found a significant association between increased patient mortality and nurse staffing below target levels. More specifically, In the February 2014 issue of the Lancet, Linda Aiken and colleagues published findings from a study conducted in European hospitals, which found that an increase in a nurses’ workload by one patient increased the likelihood of dying within 30 days of admission by 7%.4
These should be alarming numbers for any hospital. The cost of a staffing shortage is far too great, and it is not looking to improve anytime soon. Given the growing demand for healthcare services, reports project that 1.2 million new registered nurses (RNs) will be needed by 2030 to address the current shortage.5 However, the combination of limited faculty in training programs and universities, the upcoming retirement of a large part of the workforce, and the association of burnout to the profession are going to make that goal of new nurses very difficult to hit. As the pandemic continues, health systems will continue to face limitations and resource shortages for everything from equipment, supplies, and beds to doctors and administrative staff. However, the shortage of qualified nurses due to burnout will be the most significant challenge of all.
Today’s EHR solutions are not designed for clinical care delivery especially for telemedicine or virtual-ICU’s, instead they are built and based on previously existing hospital billing systems. These hospital billing systems have been adapted as a nested spreadsheet with clinical data to attempt to deliver clinical care. This model has created multiple data areas that doctors and nurses need to search to find relevant clinical data and are a source of intense pain and anguish for healthcare workers. EHR’s have also been the ire of many articles over the past few years including Why Physicians Hate Their Computers and Death by 1,000 Clicks: Where Electronic Health Records Went Wrong. A more recent article in The Atlantic illustrates these points very clearly. They state, “Health-care workers aren't quitting because they can’t handle their jobs. They’re quitting because they can’t handle being unable to do their jobs. Even before COVID-19, many of them struggled to bridge the gap between the noble ideals of their profession and the realities of its business. The pandemic simply pushed them past the limits of that compromise.”6 Clearly these EHR solutions are the major contributor in healthcare workers inability to do their jobs and continues to create undue stress on our healthcare heroes.
What can hospitals do to alleviate the staffing shortage?
While there are initiatives underway to support the education of new nurses and incentives for entering the profession (such as loan forgiveness and health system partnerships), that doesn’t leave much to the control of hospitals and health systems7 . While these organizations can research incentives to attract and retain top nursing talent, one major aspect that cannot be overlooked is upcoming technology advancements. Health systems need to research tools that make the jobs of their current staff easier. The benefits are endless if they can effectively alleviate the workload of each worker. This includes reductions in mortality, cost savings, an increase in quality of care, a decrease in nurse turnover and burnout, and much more. A few major technologies that health systems are turning to is the use of bedside clinical analytics tools that reduce the clicks and manual computer effort required to care for patients, remote patient monitoring, and the virtual-ICU.
Real-Time Clinical Analytics Applications
One specific technology is a completely portable real-time clinical analytics solution that is Software as a Medical Device (SaMD) and FDA cleared. Solutions like this allow hospitalists or Intensivist’s to provide complex, comprehensive, and collaborative virtual-ICU or virtual acute care from anywhere using just a laptop. In today’s virtual-ICU or telemedicine acute care environment, a hospitalist or intensivist doesn’t have access to all EHR data integrated into a single view on a clinical analytics platform. In addition, if that intensivist or hospitalist is monitoring multiple hospitals, she/he certainly will have to bounce in and out of multiple EHRs as well as their tele-ICU solution. Portable real-time clinical analytics solutions that have full EHR clinical data integration allows the physician or nurse to skip having to flip back and forth between the virtual-ICU system and multiple EHR’s. Having all the data in one place combined with AI and Machine Learning algorithms to help assess and treat patients allows physicians and nurses the ability to monitor many more patients than they can today, and they can do it from anywhere, rendering today’s expensive hub style tele-ICU command centers much less important and over time likely irrelevant.
The ability to have physicians and nurses utilize remote patient monitoring from anywhere in any acute care setting including a virtual-ICU, will drive massive efficiency and help ease the current and escalating clinical labor shortage in two ways. One, it will reduce the stress placed on nurses and physicians (or any provider for that matter) by poor technology designed for billing rather than clinical care. Second, the efficiency from these systems will allow existing clinicians the ability to effectively care for much larger numbers of patients without creating fatigue and stress. This is especially important in rural areas where physician shortages are growing more rapidly and putting people who live in remote areas at major risk of not having the clinical expertise available when needed. A recent article pointed out that, “Rural areas could experience more problems because of the physician shortage than urban areas. According to current data for Healthcare Professional Shortage Areas (HPSAs), mostly-rural states such as Utah, Vermont, Tennessee, as well as remote territories like Guam and the Northern Mariana Islands, have the highest shortages in medical professionals per capita.”8
Completely portable real-time virtual-ICU and virtual acute care solutions that are FDA cleared allows Intensivists and Hospitalists to be part of a Clinical Mesh Network instead of having to drive or travel to a Hub. Combined with analytics that help drive a diagnosis and the care bundle, a physician can sit anywhere and care for more patients in (even without a $20K home setup) and do it all from within one solution. The virtual-ICU market is demanding not just 24/7 Clinical Command Centers but Clinical Mesh Networks that provide for Ad-Hoc and On-Demand ICU care or home care.
The AWARE Sepsis DART platform uses AI/ML based algorithms to significantly reduce the amount of time required to assess and treat patients. In addition, peer-reviewed research shows it reduces errors by up to 50% thereby also reducing a primary driver of clinician and nursing time, fixing errors9 . The AWARE Sepsis DART platform was developed by combining Health IT with human factor ergonomics and System Engineering to design a system that extracts high value data from the EMR and presents it to the clinical and nursing teams in patient centric information packages10 .
By using AI based algorithms or rules the clinical and nursing teams can eliminate the thousands of clicks required to manually extract data from the EMR as highlighted in the aforementioned article “Death by 1000 Clicks” and save on average 25% of the time it takes to assess, diagnose, and deliver care to a patient. These types of AI based algorithms have been successfully used in our personal lives and many industries to automatically extract and present the most relevant information for a given task.
Known for its industry leading DART™ sepsis solutions, agnostic solutions like Ambient’s AWARE™ (virtual-ICU) saves lives and provides all the needed EHR data in one solution. Delivering true virtual-ICU and telemedicine acute care (regardless of a patient’s location) requires having lightweight solutions that are platform independent and camera agnostic. True telemedicine care in all settings of acute care from the ICU to skilled or long-term nursing facilities, and even into the home is the ultimate goal to help alleviate the labor crisis for nurses and medical doctors.
Tele-ICU and Remote Patient Monitoring
Traditional telehealth and virtual ICU’s have surged across the country in the wake of COVID-19, but traditional telehealth solutions only solve a portion of the problem. Virtual-ICU software requires FDA clearance for active patient monitoring. A complete platform for a Virtual ICU requires access to traditional telehealth, integrated with additional clinical analytics and data visualization. Integrated virtual ICU platforms allow physicians and nurses to effectively monitor all hospital beds, in addition to the ICU beds, and will help track patient deterioration using automatic APACHE IV, SOFA, Sepsis, & Ventilator Induced Lung Injury (VILI) types of scoring and sniffers. This is critical during the COVID-19 pandemic. Integrating early warnings and changes in a patient’s condition with traditional telehealth software, along with the ability to track and monitor patients from admit to discharge, make virtual ICU platforms ideal for dealing with the current nursing labor shortage.
Virtual ICU platforms drive situational awareness by providing a health system’s clinical staff the ability to utilize remote patient monitoring and manage every bed in the health system like it is an ICU bed. Using point of care access to vital process-of-care information and real-time analytics allows health systems to increase their ability to handle ICU surges and improve the safety for both the clinicians and the patients.
It is evident that despite improvements in modern tele-ICU’s, most current approaches to virtual ICU care and remote patient monitoring fall short of providing the data visualization and clinical decision support tools required to effectively care for critically ill patients. Over the years and especially through this pandemic, we have learned that AWARE's innovative virtual ICU UX design focuses on delivering those requirements while reducing information overload and making it possible to prioritize clinically important information. AWARE’s Remote Patient Monitoring implementations have been associated with marked improvement in clinical outcomes. “Adjusted for illness severity, the odds for hospital mortality of critically ill patients treated after AWARE implementation were reduced by half (odds ratio 0.45, 95% confidence interval 0.30 to 0.70). In addition, the length of ICU stay decreased by 50%, length of hospital stays by 37%, and total charges for hospital stay by 30% ($43,745 per hospital admission).”11
Other key outcomes that have been measured include:
Provider Level: cognitive load, safety culture, team communication, satisfaction, technology usage.
System Level: Processes of care targets will be identified with local practice but may include items such as the use of non-invasive and low tidal volume modes of ventilation, judicious fluid resuscitation and shock reversal, restricted blood product use, DVT prophylaxis, central device removal, goals of care discussion, and sepsis bundle of care compliance.
Patient Level: ICU and overall hospital mortality (unadjusted and severity of illness adjusted), ICU and overall hospital length of stay, ventilator-free days, discharge location, and better communications to families.
Unit Level: Development of numerous unit-based algorithms covering all aspects of critical care.
These are key outcomes that every health system should strive for as they select a virtual ICU solution. Meeting the nurses and physician requirements for your virtual ICU must also take into consideration remote patient monitoring for the larger general inpatient, ED, and any other beds outside of your critical care units. Ignoring the patient population outside of the critical care areas typically ends in a selection of a very narrow virtual ICU solution, and long-term ultimately results in hospitals and health systems having to purchase expensive duplicative solutions and IT having to manage multiple solutions.
Understanding these factors will help guide your team to make an informed and appropriate selection of an enterprise platform that best improves patient care, reduces clinical staff burnout, while meeting your hospital and health system needs. Although there are a multitude of elements playing into the labor shortage within health systems, adding remote patient monitoring and tele-ICU solutions to your tool kits will be vital to combating the ongoing labor shortage.
About Ambient Clinical Analytics
AWARE™ Critical Care
Ambient has achieved FDA Class II Clearance, CE Marking, and ISO 13485:2016 Certification on the AWARE™ platform. AWARE™ provides remote patient monitoring and predictive analytics combined with novel clinical decision support tools that reduce provider fatigue, errors, and saves lives. Created by clinicians for clinicians, AWARE™ delivers real-time virtual-ICU surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
In additiuon to providing virtual-ICU camera functionality, AWARE’s (Ambient Warning and Response Evaluation) virtual-ICU solution is designed to provide bedside and remote patient monitoring from anywhere using data visualization and clinical analytics. The AWARE™ Multi-Patient Viewer (MPV) and Single-Patient Viewer (SPV) allows all nurses and physicians to view a patient through the eyes of a intensivists. Critical care requires turning massive amounts of raw data into actionable knowledge and many of the electronic tools at your disposal make this much more complicated than necessary.
This complication, commonly known as information overload, frustrates clinicians and exposes patients to diagnostic errors and therapeutic harm. AWARE™ is different, it was built by intensivists with Mayo Clinic using principles of human factors engineering, gathering the data that’s important to critical care teams and displaying it in a way that minimizes cognitive load. AWARE™ is the gold standard for how smart clinical analytics and data visualization can improve communication, efficiency, situational awareness, and safety. Unlike any other system, AWARE™ shows you what you need to see, at the point of care and in virtual ICU settings, organized the way an intensivist approaches their patients’ data.
AWARE Clinical Control Tower™ is a solution designed to provide a virtual ICU or acute care anywhere for both AWARE™ and Sepsis DART™ with centralized or decentralized remote patient monitoring and collaboration for physicians and nurses. AWARE™ and Sepsis DART™ capabilities are delivered to all locations in a standardized format, eliminating EMR differences. Clinical Control Tower™ provides distributed tele-health, virtual-ICU and remote patient monitoring within your system and with any contracted facilities.
Whether deployed in an ICU or as a virtual ICU solution, the AWARE™ enterprise class family of solutions including Sepsis DART, AWARE Critical Care, and Clinical Control Tower all help you approach your patients in a more effective, informed, and organized fashion while decreasing provider fatigue, reducing errors, and saving lives. Created by clinicians for clinicians, AWARE™ delivers real-time surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
The combination of effective predictive analytics and advanced clinical decision support tools helps to reduces errors, improve patient outcomes, reduce the cost of care, and deliver best-care practices for ICUs and other inpatient care areas. AWARE’s predictive analytics system provides a “smart view” via data visualization of Electronic Health Record data that reduces the risk of medical errors and improves patient outcomes with high reliability healthcare. It works with your EMR and bedside monitors to present only relevant information for care delivery. This minimizes information overload, which is a leading cause of medical errors, and results in a lower cost of care. By facilitating quick access to patients’ information at the point of care and in remote patient monitoring centers using AWARE’s Clinical Control Tower™, Ambient aids interventional decision-making and is proven to reduce the incidence of cognitive errors by 50%.
For more detailed information about Ambient Clinical Analytics please contact tim.kuebelbeck@ambientclinical.com.
About Ambient Clinical Analytics - Ambient is an industry leader supporting leading healthcare systems and has done so since its founding in 2013. Our solutions are designed by clinicians to be easy-to-use by every caregiver in your organization and are configured to be up and running rapidly. We are trusted by a community of high-performing healthcare providers across the United States. Our solutions are powerful real-time point-of-care and remote healthcare platforms designed to deliver life-saving analytics and solutions using data visualization, communication, analytics and rules based clinical decision support.
Ambient’s AWARE™ and Sepsis DART™ solutions are exceptionally secure, high-performance, FDA Class II approved and CE Marking certified Software as a Medical Device (SaMD) platforms. Ambient’s Sepsis DART™ product has been accepted into the Patient Safety Movement’s Actionable Patient Safety Solutions (APSS) #9 for Sepsis. Ambient has achieved ISO 13485:2016 certification, an internationally recognized quality standard specific to the medical device industry. The ISO 13485 standard sets out the requirements for a quality management system specific to the medical device industry. Ambient is also deploying the AWARE™ family of solutions, to help manage COVID-19. Ambient’s Virtual-ICU platforms are ideal for any acute patient care setting including the virtual-ICU. For more information, visit https://ambientclinical.com.
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