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Applications Tim Wright Applications Tim Wright Presentation Transcript

  • Remote Presence Applications International Distributor’s Open House
  • Anytime Anywhere Care Patient Satisfaction Hospital Throughput Physician Efficiency Patient Safety Remote Presence Patient Ward Rounds Critical Care Units Emergency Department Remote Outreach Advances Key Hospital Initiatives
  • ICU Remote Intensivist Coverage
    • Overview
      • ICU care is 4x more expensive than M/S care
      • ICU spending = 1% of GDP
      • Fast pace, complexity and severity make ICUs the #1 in medical errors
      • Intensivist-led care is proven solution, but nationwide shortage exists
      • Remote Presence can deliver intensivist coverage across multiple ICU’s
    • Objectives
      • Meet JCAHO, IHI, Leapfrog patient safety standards
        • More frequent intensivist and daily team rounds
        • Ventilator, BSI, and sepsis care bundles
        • Rapid Response Teams
      • Reduce clinical outliers
    • Value Proposition
      • Compliance with national patient safety initiatives
      • Reduce ICU LOS by 18% ($180,000 per bed annually)
      • Reduce ICU admissions by 15% ($65,000 per bed annually)
      • Reduce ancillary costs by 15% ($26,000 per bed annually)
      • Reduce ICU mortality by 40%
    Problem: 20% of ICU patients experience serious adverse events, Over 54,000 ICU deaths could be prevented each year
  • Parkview Hospital Evening Admission
  • Parkview Hospitals
    • Achieve compliance with IHI standards
      • Team rounds and spot checks enable 100% compliance on vent bundle
        • Reduced VAP to zero saving $30,000 per case
      • Rapid Response Teams reduce “out of ICU” codes from 6 to 1 per month
        • Off-ICU codes have 40% chance of survival and average cost $215,000
    • Achieve compliance with JCAHO standards
      • 100% restraint protocol compliance saving $100,000 resurvey
    • High nurse and staff satisfaction
      • 25% improvement in staff satisfaction
      • ICU job vacancy down from 20% to 5%
    Remote ICU staff covers 5 hospital ICU’s and patient wards in Ft. Wayne, Indiana
  • UCLA Medical Center
    • Daybreak rounds, daytime spot checks, proactive evening rounds
      • Improve education & supervision of residents
      • Improved ICU bed turnover due to more rapid off-hours triage
      • Faster attending-level treatment decisions on critical care patients
      • Increase compliance with ICU standard protocols
      • Improve nursing and family satisfaction
    Increased neuro-intensivist coverage in academic hospital setting
  • California Pacific Medical
    • Remote access to pediatrics ICU from physicians offices & homes
      • Increased daytime and after-hours coverage
      • Improved patient and family communications - increased satisfaction
      • Convenience and satisfaction for physicians
    Increased specialists coverage of pediatrics ICU and patient ward “ I used to sleep over at office just to cover my pediatric patients.” Michael D. Black, MD
  • Physician Rounds on Med/Surg Floors
    • Solution
      • Connect targeted physicians from home, office, sister hospital
      • Currently: Urology, Bariatric, Cardiac, Orthopedic, Neuro, Parinatology, Burn units, pediatric units
    • Hospital drivers
      • Reduce patient LOS by hours or even days
    • Physician drivers
      • Improve patient satisfaction
      • Improve physician efficiency
    Problem: Once daily physician rounds extends patient stays
  • Hackensack UMC
    • New rounding protocol
      • Robotic rounds used to deliver discharge orders before 11AM each day
      • Reduce PM discharges by 80% - improve efficiency & throughput
      • Physicians reimbursed; study used to support new reimbursement code
    • Hospital financial benefit
      • Each PM discharge equates to 1 lost day or $1,000
      • Robotic AM rounds can release 25 additional beds
      • $9 million annual benefit to hospital
    25 patients/day are unnecessarily discharged in PM instead of AM hours
  • Dr. John Davis Urology Post Surgical Rounds
  • Devine-Tidewater Urology
    • Urologists perform supplemental afternoon rounds on 62 post-surgical patients
    • Financial impact
      • In a 42 bed ward, the est. value of .29 day LOS reduction exceeds $1.4 million/year
        • $508,000 marginal cost savings (1270 fewer days for current patients)
        • $989,000 marginal value of 396 new patient admissions
    Supplemental robotic rounds reduces hospital LOS 19% 12 Discharge orders provided 29% 18 Patient discharge advanced 65% 40 Medical orders provided Percent Totals Robotic Rounds
  • Sinai Hospital
    • Robotic rounds in bariatric surgery
      • Increased patient throughput
      • Cost savings and increased revenue for hospital
      • High patient satisfaction leading to increased referrals
      • Higher case volume and high physician satisfaction
    Reduced LOS, increased throughput and high patient satisfaction “ I do remote rounds as often as three times a day. Currently, 80% of my patients are being discharged on post-up day one.” Alex Gandsas, MD “ One night when I was feeling low and worried about my health, Dr. Gandsas, visited with me through the Robot in real-time! That’s what this represents – peace of mind for patients” Name Withheld
  • ED Specialty Consults
    • Solution
      • Connect key specialists from home, office, another hospital, elsewhere in the hospital (cath lab, ICU, OR)
    • Clinical drivers
      • Cardiac program – timely cardiologist
      • Stroke program – timely neurologist
      • High risk pregnancy – timely parinatologist
      • Address ED delay JCAHO/Patient safety risk
      • Improve continuity for ICU bound patients
    • Business drivers
      • Solution to ED Call Panel issues
      • “ 30 Minute Guarantee” marketing campaign
      • Reduce hospital diversions (4 lost admits/ hr)
      • Improve ED patient satisfaction
    Problem: Long ED wait-times, survey risk, and call panel recruiting
  • Detroit Medical Center
    • Provide timely ED call panel coverage, thereby improving ED efficiency and reducing wait times
    • Active participation from cardiology, neurosurgery, pediatrics, general surgery, critical care, urology, perinatology & dermatology
    • Reduce non-critical ED wait-time from as high as 12 hrs to 2 hrs
    Improved ED call panel coverage and access to specialist
  • Remote Outreach
    • Solution
      • Connect specialist from ‘Host’ Hospital (ED, ICU, Other) to smaller remote hospital
        • Rural (limited access) hospital
        • Single specialty hospital (without full set of specialty services)
    • Clinical drivers
      • Shortage of specialty services in remote markets
      • Involve clinical experts earlier in treatment
    • Business drivers
      • Drive specialty service referrals to Host hospital
      • Establish Host hospital system as market leaders
      • Enable remote hospital to avoid unnecessary transfers
    Problem: Access to Expert Care
  • Detroit Medical Center
    • New protocol
      • Harper Hospital intensivist manages MIOSH ICU patient from office and home
    • System benefits
      • Improve patient safety – reduce risk
      • Leverage the DMC clinical capability to remote hospital
      • Train/coach remote hospital team
      • Avoid unnecessary transfer
      • Improve continuity of care
      • Improve patient satisfaction
    Surgery outliers are high risk for distant orthopedic specialty hospital
  • Current Hospital Applications
    • Intensive Care
    • Increase Intensivist presence
    • Admission/discharge/transfers
    • Nights/weekends call response
    • ICU staff training and support
    • Resident oversight
    • Evening rounds
    • Family meetings
    • Rapid Response Teams
    • Code Blue Team
    • Leapfrog/IHI compliance
    • Leverage eICU team
    • Supplemental Surgical Rounds
    • Urology
    • Bariatric
    • Cardiac
    • Orthopedic
    • Neuro
    • Burn units, pediatric units
    • Supplemental Medicine Rounds
    • Supplemental morning rounds
    • Geriatric rounds
    • Cath Lab
    • Cath patient recovery oversight
    • ED consults from Cath Lab
    • ED Consults
    • General surgeon
    • Pediatric surgeon
    • Urology
    • Cardiology – Chest protocol
    • Neurology – Stroke protocol
    • High risk pregnancy
    • Dermatology
    • Surgical Process
    • Pre-op anesthesiology patient exams
    • Neuro-surgery head positioning
    • Rehabilitation
    • Patient consults
    • Rehab oversight
    • Outreach
    • Major Academic Hospital to suburban hospitals or specialty hospitals
    • Larger hospitals to small rural hospitals
    • Other
    • Translation services
    • Isolation patient management
    • Night nurse in-service and education
    • Security
    • Surgical proctoring