Luann Tirelli, RN, BSN, MHA, MSN/ED, CCRN-E, CNRN, NHCE VitalWatch eICU Operations Manager, Health First Corporate, Rockledge, FL Luann.Tirelli@health-first.org

Non-financial: Speaker is employed by Health First Inc. located in Rockledge, Florida

Speaker will not be endorsing or supporting the use of any devices or products in this presentation

Financial: Speaker has a signed agreement

with Philips Healthcare and will abide by all stipulations specified in this binding legal agreement

• Describe the Health First VitalWatch® eICU® eMobile Cart program

• Assess the value of mobile critical care for patient management

• Evaluate the results of the eMobile Cart program for improving outcomes and generating meaningful cost avoidance

• Recognize the potential of mobile critical care for use in other health care environments

Central Florida's only fully integrated Health System

• - Outpatient & Wellness Services • - Trauma & Heart Centers • - eICU Telemedicine Services • - Multiple commercial & • Medicare health plans • - 4 comp. Fitness centers • -Area’s largest multi-specialty • Physician group • - Aging Services • - Family Pharmacy Center • - DME Company • - Private Duty services • - Wound Care/Hyperbaric • - Sleep Centers

*900 Acute-care beds *345 Progressive-care beds

*Trauma Center *VitalWatch® eICU®

Cape Canaveral Hospital

Palm Bay

Hospital

Holmes Regional Medical Center

Viera Hospital

• VitalWatch®eICU®– a remote ICU team – Intensivist Medical Director - (1) – Operations Manager/Director - (1) – Critical Care Intensivists - (16) – Critical Care Nurses - (18) – ePharmD Clinical Specialist - (1) – Health Unit Coordinators - (6) – Physician/eICU Coordinator – (1)

2004 Health First establishes VitalWatch® First eICU in the Southeastern U.S. Monitoring of all Health First hospital ICU’s >60,000 Patient interactions a year

• 2003 – Rapid Response Teams (RRT’s) – Institute for Healthcare Improvement (IHI) – Evaluate patients who suddenly deteriorate

• Health First RRT (2003) – ICU Nurse – Respiratory Therapist – On-site Physician or Hospitalist

VitalWatch® eICU® (2010)

RRT historically at Health First Challenge – Collaborative care delivery in a timely manner VitalWatch® eICU®to the rescue System-wide approval – MEC/Executive Team System-wide education Change in eICU team workflow

BUT HOW?

Downgrade Throughput

Support by Telemedicine: -Connected to VitalWatch® eICU® -All four Health First hospitals -Wireless Mobile Carts -Secure HIPAA Compliant Network

eSNF Consults

RRT SUPPORT

Translation Services

ASL Services

The eMobile Cart

Use of an AV communication device

Which of the following would be a potential outcome of a eMobile cart program?

A. Reduced care costs B. Controlled care services & throughput C. Decreased inappropriate status upgrades D. Improved mortality E. Revenue generation F. Retention of Staff

Concern: Will there be an increase in transfer to ICU’s using a telepresence platform?

NO Raw data analysis has shown that less patients

had an upgrade to ICU status when eMobile cart support was provided by the eICU team.

RRT Evaluation of Patients without an Upgrade to ICU status

Year(Jan-Dec)

Total # eMobile- Assisted

RRTCalls

Percentage patients w/o

Status Upgrade

Total # Non-Assisted RRT

Calls

Non-eMobile Assisted

Percentage patients w/o

Status UpgradePre-eMobileCart 2009 311 27%Start eMobileCart2010 204 38% 205 37%

2011 249 36% 127 36%2012 209 34% 215 34%2013 218 33% 183 33%2014 244 39% 360 32%2015 263 35% 307 34%

Average 36% 34%

Concern: Would eMobile cart intervention improve overall mortality?

YES Since the eMobile cart program start, patients

cared for by the eICU team have a lower incidence of expiration during hospitalization

% of Expirations during Hospital stay for RRT patients

Year(Jan-Dec)

eMobile- Assisted RRTFinal Disp.:Expired

Non-eMobile- Assisted RRTFinal Disp.:Expired

Pre-eMobileCart 2009 n/a n/aStart eMobileCart2010 n/a n/a

2011 18% 24%2012 25% 50%2013 13% 20%2014 19% 19%2015 17% 17%

Average 18% 25%

Concern: With investment in an eMobile cart program, can there be significant cost avoidance?

HECK YEAH!

Show me the money !!!

Year (Jan-Dec)

# w/o Status Upgrade

Transfer costs *1

ICU Bed Cost *2

Med-Surg Bed Cost

1 day LOS N- Cost

Avoidance

2 day LOS N- Cost

Avoidance

3 day LOS N- Cost

Avoidance

Pre - eMobile Cart

2009 N=78 $39K $1,250 $300 $74.1k $148.2K $222.3K

Start eMobile Cart

2010 N=71 $35.5K $1,220 $300 $65.3K $130K $195.9K

2011 N=68 $34K $1,230 $300 $63.2K $126.4 $189.6K

2012 N=70 $35K $1,200 $300 $63.0K $126.0K $189.0K

2013 N=72 $36K $1,200 $335 $62.3K $124.6K $186.9K

2014 N=126 $63K $1,800 $600 $151.2K $302.4K $453.6K

2015 N=124 $62K $2,000 $900 $136.4K $272.8K $409.2K

2010 - 2015 Calculations 531 $265.5K $541.4K $1.08M $1.62M

2010 - 2015 Total Cost Avoidances (Transfer + Daily costs)

$807K $1.35M $1.89M

Dollar Spent Analysis Calculation 2014 Value 2015 ValuePatients Managed without ICU Upgrade n=126 n= 124Savings on Transfer Patients w/o transfer movement x $500 $63,000 $62,000CA on Means ICU Stay Patients x ICU cost x Avg ICU LOS/d 2.6d $655,200 2.5d $620,000Gross Savings on eMobile Transfer + ICU stay $718,200 $682,000IT eMobile Budget IT Costs $167,000 $167,000Net Savings FY (Transfer + ICU) - IT $551,200 $515,000Return on Investment FY Net / IT Cost $3.30/1 $3.08/1

What could be some indirect outcomes from an eMobile cart program?

Increased Staff Satisfaction

Increased Patient/Family Satisfaction

Increased HCAHPS scoring

Regional/National recognition

Revenue generation: outsourcing

eMobile Cart program: It is an effective means of extending critical care expertise beyond the ICU setting

Synergy among different service lines

within a healthcare entity is crucial to an eMobile Cart program’s success

Linking tele-ICU support to an

eMobile program improves care delivery leading to optimization of human and material resources