Leyton StevensDirector of HealthcareBES Rehab Ltd

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

• Cost of treating pressure ulcers: £2.1bn annually1

NHS Statistics

1. Bennett, G et al (2004) The Cost of Pressure Ulcers in the UK2. National Institute for Health and Care Excellence (2013) Falls: the assessment and prevention of falls in older people3. Tian, Y et al (2013) Exploring the system wide cost of falls in Torbay4. NHS Confederation (2016) Key Statistics on the NHS5. 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

What is EarlySense?

Around the clock care, bed and chair sensors

Contact-Free Sensor

What is EarlySense?

Heart Rate

Respiratory rate

Motion

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 SurgicalCoffee Regional Medical Center, Douglas, GA

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

What are the costs?Falls

• 3.4 million people (1 in 3) over 65 have an injury from a fall each year

• A high percentage of falls are unwitnessed2

• 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.

• Cost to NHS: £4.6 million a day

• Cost to NHS: £2 billion a year

• Patient falls occur in up to 3% of all acute care hospitalizations

• An estimated 30% of inpatient falls result in serious injury1

• The bedside is the most common place for falls to occur2

Reducing the incidence of falls

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

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.

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

Reducing the incidence of Pressure Ulcers

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

Vitals tracking

Critical events are estimated to occur in up to 17% of patient admissions1

1. The Joint Commission Guidelines2. Schein R.M. et al, Chest 1990; 98: 1388-92.3. Franklin C. & Mathew J. Critical care medicine 22, 244-2474. Young MP et al, J Gen Intern Med. 2003; 18: 77-835. 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

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 prescribedOutcome: 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

Paperless Recording of Dataalong with Trend Analysis

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 Deteriorations2. LifeSync: LifeSync Wireless ECG System… Increases ECG Alarm Accuracy3. 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

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

AdmissionAnnual Savings

1. Base Case Total cost of intervention effects $710 $1,701,600

1. Conservative Includes only direct variable costComponent 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

EarlySense cost comparison

With EarlySense (33 beds implementation)

Without EarlySense (90 beds)

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