Good Shepherd Medical Center Device Connectivity Case Study

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1 Good Shepherd Medical Center Device Connectivity Case Study How Nuvon Improved Time for Patient Care in the ED, Provided Better Patient Triage, and Supported Increased ED Throughput Capacity While Going from Installation to Test to Live in less than 48 hours

2 Good Shepherd Medical Center Device Connectivity Case Study How Nuvon Improved Time for Patient Care in the ED and Generated Potential Throughput Capacity in Excess of $430,000 Annually While Going from Installation to Test to Live in less than 48 hours Background Good Shepherd Medical Center is based in Longview, Texas. A Level II Trauma Center that covers the northeastern corner of Texas, extending north to Oklahoma and east to Louisiana, the hospital is licensed for 425 beds. The hospital is fourth in the state for Emergency Department volume, making it a major healthcare provider for the state. It draws from an 11 county draw area in East Texas treating approximately 88,000 Emergency Department (ED) patients in With more than 80 percent of Good Shepherd s admissions coming from the ED, a great deal of the success of the hospital is dependent upon the operational efficiency of its ED. Facility Type Short Term Acute Care Trauma Center Designation Adult Level II Typical Workflow Scenario As is typical in most hospitals, the protocol Good Shepherd follows when a patient arrives at the ED either via ambulance, car or even on foot is for a triage nurse to see the patient and assess the complaint, take vital signs, and then escort the patient to a room or examining area to be seen by the doctor. While in the room, the patient s vitals are taken again. Once in the examination area and depending upon the patient s history and complaint, the patient can also be connected to various medical devices that are appropriate for the care of that individual. These devices monitor specific vital signs of the patient. Then, the doctor evaluates the patient and decides upon a treatment that will either be performed in the emergency room or that may require the patient to be admitted to the hospital Nuvon, Inc. All Rights Reserved. 2 P age

3 Importance of Vital Signs A patient s vital signs are important indicators of the patient s condition upon entry to a facility. They are used to determine the general parameters of the patient s health and viability, and are crucial for establishing a diagnosis and subsequent treatment. Because there are a myriad of potential interactions that can occur, ongoing monitoring of vitals is essential. For example, not only is the dosage of the medication often titrated from information contained in the vitals, but different types of medications can have different impacts on the patient as conditions develop. So, vigilant monitoring of vital signs, allergies, medication reconciliation, and/or contraindications is important to prevent adverse effects. Each Acute Care department has a specific set of protocols that specify the time intervals between each assessment of vital signs depending on the patient s diagnosis and/or treatment plan. For example, for seriously ill patients, vitals may need to be taken every five to fifteen minutes. Focus on Patient Care and Safety, not Paperwork A June 2010 report from HealthGrades 1 states that hospital emergency departments play a vital role in saving lives. In fact, according to the report, nearly 120,000 patient deaths could have been prevented with better emergency care. However, these departments are overburdened, underfunded, and highly fragmented. With an average of nearly 250 patients per day, Good Shepherds busy ED illustrates just how crowded emergency departments can become, making it vital for the ED to function as efficiently as possible. Facilities are seeking ways to improve patient care and the clinician s workflow efficiency. Large numbers of patients seen in the ED also increase clinician efforts to triage and treat patients. In many cases, IV infusion pumps, patient monitors and other devices collect important information for each patient that must later be transposed into the patient s chart. For those facilities still on paper charts, not electronic records, the workflow efforts and opportunities for error increases. And, depending upon the patient, the clinical data may need to be collected every 5 to 15 minutes from every medical device monitoring the patient. Adding to the hectic pace of the ED, patient charting requires manual transcription and entry a time- consuming process. A nurse or nurse s aide visits each patient individually, takes and 1 HealthGrades Emergency Medicine in American Hospitals Study. June Nuvon, Inc. All Rights Reserved. 3 P age

4 records vital signs and transfers the information to the patient s chart. If the record is paper, and many still are, the workload can significantly increase because the chart may or may not be available at the time the clinician desires to write the information in the chart. If a facility is on an electronic record, like Good Shepherd, the efforts are eased somewhat because records can be viewed and updated simultaneously by multiple clinicians. On average, it takes approximately 2-3 minutes to complete the process of recording clinical data in each patient s chart and this estimate assumes no interruptions, such as a patient needing care or a doctor needing assistance. If that happened, there would be a delay in entering the data into the patient s chart, which could impact diagnosis or treatment. Even though the record is electronic, any time there are human- machine interactions, it introduces opportunities for errors This was one of The ED nurses at Good Shepherd, who were continually the smoothest balancing their time between patient care, assessments, clinical communications with providers, and nursing implementations documentation, realized that one way to help them focus the I ve been involved bulk of their time and efforts on the patients not on charting was through medical device connectivity. If medical with. devices are connected and/or able to securely transmit device data to a patient s record, significant improvements in clinical workflow, accuracy and availability of patient data would result. This capability provides more time for direct nursing care to patients and shifts the focus from documentation to improved clinician communications and on caring for their patients. At Good Shepherd, nurses saw the opportunity and began lobbying hospital management to get improved transmission of device data into the patient s electronic record. Hospital management also recognized these opportunities for workflow efficiencies and improved patient care that could be obtained in the busy ED and authorized the installation of a Nuvon vitals interface in September of Smooth Implementation Frequently, when new technologies are deployed there can be a disruptive impact to the clinical workflow. That wasn t the case with the Nuvon vitals interface. According to Crystal M. Thornton, ED Nurse Director for Good Shepherd, setting up the system and getting the staff trained on it was one of the easiest things she had ever done. This was one of the smoothest implementations I ve been involved with, she says. The system interfaced very well with the MEDHOST system [the hospital s Emergency Department Information System (EDIS) which contains the patient s EMR] and there was virtually no training or learning curve for the nurses. The system is self- explanatory and, although I did make sure 2011 Nuvon, Inc. All Rights Reserved. 4 P age

5 they could use it, our nurses picked it up very quickly. From day one, we have been using the system and we ve never had one problem with it. Functioning as the conduit that gets vitals from the patient monitor to the MEDHOST EDIS system, Nuvon s vitals interface taps into the existing network infrastructure of the Good Shepherd clinical system and pulls up the raw data, recalling the vitals from a specific patient monitor and then pushing it to the MEDHOST EDIS. Nurses are able to go to a specific vitals screen, where they will see the most recent 10 to 15 vitals in the same form that appears on the patient monitor. They then verify the vitals, simply select whichever data they want, import them to the MEDHOST system and automatically pull them into the patient s chart. Thornton says that when the system first went live, she did manual spot checks to make sure that there were no problems and that information on the monitor matched what was being pulled into the patient s EMR but, I ve stopped doing that, it was always accurate. Vitals Interface Produced Time- savings and Improved Patient Care In the Good Shepherd ED, the minimum span of time required to take a patient s vital signs is every two hours. Before the installation of the Nuvon vitals interface, nurses had to expend considerable leg work getting the information into The IDM- MG 4000 provides connectivity to the MEDHOST EDIS the patient s EMR. First, they would read the vitals off the patient monitor and write them down. Then, taking this slip of paper, they would return to the nurse s station where they would type the vitals into the system. In some cases, the nurse would take the vitals off the central monitoring station, print them, and take that printed piece of paper to the nursing console to type the vitals into MEDHOST. Once the Nuvon system was installed, time decreased from minutes to seconds to review and enter patient monitor data and/or vital sign entries. Nurses were no longer required to write down each value from a patient s monitor or device, instead they approved and automatically transmitted the information at the bedside directly into the patient s record. Of the approximate 88,000 patients treated in the ED in 2009, 55,000 patients, about 60 percent, had critical needs requiring patient monitors, says Thornton. With the Nuvon vitals interface, the nurses workload has definitely decreased and it has given them a huge time- savings. The convenience of being able to go to the charting station and actually complete their documentation, including the vital signs, at one sitting is so much more efficient and accurate. In addition, because the process is not as long, the frequency of documenting the vital signs has increased Nuvon, Inc. All Rights Reserved. 5 P age

6 The charting time saved by the nursing staff lets them spend significantly more time with the patient, or rounding with the other patients that they may have under their care at that point in time. But the benefit of the Nuvon vitals interface is not limited to time savings alone because the information is taken directly from the device it is accurate and not subject to human error. The nursing staff is not the only beneficiary of the Nuvon vitals interface. Physicians are seeing a benefit, too. Because they can get their patient s vitals right away, doctors do not have to wait for the nurse to input this data. Consequently, they are able to have better information to make decisions at the point of care. The availability of patients clinical data at the point of care leads to improved ability to make better diagnostic and treatment decisions. Physicians log into the MEDHOST system, look at the patients records, and see the vital signs in real- time. Because our ED volume continues to rise, a situation which we don t see abating, we need to function as efficiently as possible while still providing high- quality patient care, says Thornton. With the Nuvon vitals interface, physicians can see their patients vitals data right away without having to wait for the nursing staff to manually chart them. This lets the doctors spend more time with their patients and make faster, better decisions for their care and treatment. Additionally, doctors have the ability to log in to the MEDHOST system remotely using any web- enabled device. Interestingly, adoption of remote access tools such as smart phones, BlackBerrys, and other mobile devices to access patient records securely is becoming mainstream in a physician s workflow. They can check in from another station within the hospital, saving them from having to go to the ED. Or, if they have appropriate software and access privileges, they can remote in using their smart phone. Improved Time for Patient Care and Potential Throughput Capacity for Hospital as a Result of Vitals Interface As a result of the ED nurses not having to do the charting once the Nuvon vitals interface was implemented in the Good Shepherd ED, the departmental nurses saw time invested in better patient care, an easier ability to triage patients, and the hospital benefited from the potential for additional ED throughput capacity. Implementation: From Test Environment to Live in Less Than 48 Hours When the decision was made to implement Nuvon s vendor agnostic VEGA interface solution, the company worked with Good Shepherd s IT personnel to offer a clinician- focused system that allowed the hospital to: Define workflows so the ED nurses had more time to focus on their patients 2011 Nuvon, Inc. All Rights Reserved. 6 P age

7 Define the configuration and control for device connectivity, monitoring, and management, resulting in better allocation of personnel resources and reduced support costs Install user programmability for rapid development of institution- specific solutions Good Shepherd determined the various back- end features the hospital desired, such as the frequency of polling and auto discovery, which Nuvon s system enabled. Customization of a facility s device inventory can be easily specified through Nuvon s user interfaces, rather than lengthy programming efforts. Once the Nuvon vitals interface was deployed, Nuvon s intelligent VEGA architecture, with its medical device Autodiscovery capability, automatically began collecting data from disparate medical devices in the ED and translating the data into industry standard formats (and retaining it in its raw format), presenting the data in near real- time to the MEDHOST EDIS, and finally, enabling a nurse to select the desired data and send it to the patient s chart. Nuvon s system supports HITECH regulations, ensuring appropriate security and privacy access controls for patients electronic clinical data and protected health information. Once we determined the system requirements, the Nuvon installation and go-live implementation was astonishingly easy. The VEGA system was simple to install. By removing the need for manual charting, the potential for error in transcription is eliminated in addition to providing more time for nurses to focus on direct patient care and safety. Once we determined the system requirements, the Nuvon installation and go- live implementation was astonishingly easy, said Jonathan Tiller, Systems Analyst 2, Information Technology Division. The VEGA system was simple to install the Nuvon IT team came in, hooked up the vitals interface, tested the system, and within 48 hours the ED was using the system. It does not complicate our network configuration, and it s been running smoothly from day one. Scalable, Cost- Effective, Vendor Agnostic The Nuvon VEGA System is affordable for small to large facilities. It is extremely scalable for expansion to large populations, and it is vendor agnostic it works with all brands and types of devices, on any operating system, and can integrate with any clinical information system Nuvon, Inc. All Rights Reserved. 7 P age

8 Nuvon solves the challenge of universal device interoperability by utilizing its patent- pending VEGA (Vectored Event Grid Architecture) platform to enable any equipment to communicate without barriers. Nuvon s VEGA System spans disparate devices, networks, and protocols through an integrated system of programmable appliances that provide a scalable, cost- effective, and secure infrastructure for hospitals and clinics. Through the use of Nuvon s powerful technology, any device can be monitored and accessed remotely via an intuitive web interface improving the quality of patient care and patient safety while helping to control costs. Nuvon s transformative and truly interoperable machine- to- machine (M2M) platform for next generation device connectivity and data integration is: Device independent and operating system agnostic Scalable with robust security policies to monitor thousands of devices Designed for ease of integration Automated for a traceable audit trail for all data and actions An open architecture enabling user and third party development Nuvon s Solution Benefits Nurses, Doctors, Patients and the Hospital with: Enhanced patient care, safety, and satisfaction. Nurses are now able to focus the majority of their time on caring for their patients, not on charting. Increased clinician workflow efficiency. Clinicians can review patients vitals data without having to wait for them to be charted manually, and they can log in remotely to check on their data. Time savings. Nurses can approve and automatically transmit patient data at the bedside directly into the patient s record, decreasing the time to review and enter patient monitor data and/or vital sign entries, from an average of 2-3 minutes to seconds. Improved accuracy. Medical device connectivity enables the secure transmission of device data to a patient s record, significantly eliminating the opportunity for errors Nuvon, Inc. All Rights Reserved. 8 P age

9 Potential throughput capacity for hospital. Increased throughput potential in the ED valued at $437,000 annually based upon an average ED Critical Care census of 30 patients with vitals taken once every half hour. Hospital is positioned for future growth. Nuvon s vendor agnostic solution is scalable, cost- effective, and has a secure infrastructure it s a solution for today, and for the future. For More Information: For more information about Nuvon s innovative, affordable, and easy to install solution to the problem of medical device interoperability, contact: More information about Nuvon s VEGA System can be found on their website at About Nuvon Nuvon, Inc. is a privately held company dedicated to simplifying the management of healthcare technology, enabling clinicians to focus solely on the care of their patients, and providing real- time medical device data to improve decision- making and patient safety. Nuvon s flexible, scalable, and configurable VEGA (Vectored Event Grid Architecture) platform is designed to capture, display, and transmit real- time data at the point of care, anywhere. Nuvon s VEGA distributed network architecture supports true mobility enabling caregiver access to data and devices in any location. Nuvon has an installed base of major institutions that have recognized the value of Nuvon s breakthrough approach to defining and implementing a rich model for patient data capture, transmission, and integration in complex healthcare environments. For more information visit the Nuvon website: Nuvon, Inc. All Rights Reserved. 9 P age

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