It was one of Lehigh Valley Hospital’s tele-intensiv-ists — doctors who use high-tech equipment to monitorcritically ill patients from a remote site — speaking viaa video conferencing system. “I explained that I’d keepan eye on her while we determined the best treatment,”says Vanessa Ribaudo Kaufman, M.D., director of respi-ratory care. She and three nurses were overseeing thecare of 140 patients in eight ICUs within two hospitals.
In a $3 million command center, three miles away,Dr. Kaufman pulled up Rice’s test results. “Her echocar-diogram showed a four-inch-long blood clot extendinginto the heart. It was too big to dissolve with thrombo-lytics or extract with a catheter.” Doing nothing wasn’tan option. “The clot could travel to her lung, whichmight be fatal.”
The M.D. conferred with surgeons and specialists,then returned to Rice’s virtual bedside with their solu-tion: open heart surgery. After the clot was removed, theteen made a full recovery and is now back to her favor-ite sports: horseback riding and cheerleading. Impressedby the care she received, she’s considering a medicalcareer. “I’d like to be a midwife or surgeon, because theexperience made me realize how precious life is.”
Protecting Patients with Smarter CareHospitals all over the U.S. are showing off their
tech-savviness with such innovations as computerizedphysician order-entry systems, supply cabinets thatopen with a biometric thumbprint reading and Websites where patients can view test results — or evencheck in to the ER. To speed up diagnosis, the latest CTscanners image entire organs at a single pass. And forpatients on ventilators, a new, heart-shaped breathingtube called Mallinckrodt TaperGuard seals out bacteriafrom saliva so effectively that it cuts the risk of ventila-tor-related pneumonia up to 95 percent.
State-of-the-art technology helps doctors quicklyzero in on the right treatment, improves patient comfortand safety and can shorten hospital stays. “A growingbody of literature shows that the best way to enhancequality of care is by preventing complications,” saysDouglas Hansell, M.D., M.P.H., chief medical officerof Covidien, a Mansfield, Mass., healthcare equipmentfirm. Smart diagnosis and treatment are saving lives:An American Hospital Association survey found thatat the nation’s 100 most wired facilities, risk-adjusteddeath rates were 7.2 percent lower, on average, than atother hospitals.
Surgery 2.0Literally on the cutting edge of medicine are
intelligent ORs, where X-rays have been replaced with
interactive 3-D imaging. At Ronald Reagan UCLAMedical Center, says Neil Martin, M.D., chair of neuro-surgery, “this technology has revolutionized brain sur-gery. By touching a finger to a high-definition screen,we can see realistic reconstructions of every structurein the patient’s head, from any direction. That lets usmentally rehearse every step of an operation to findthe most advantageous approach, like a professionalgolfer visualizing every stroke and hole of a golf coursebefore he tees off.”
Instead of crowding around an operating table, sur-geons at Swedish Medical Center in Seattle sit at com-puter consoles six feet away, using fingertip controlsto manipulate a Da Vinci surgical robot’s four arms.Operations are done by inserting slender, bendableinstruments attached to the arms through dime-sizedincisions, which doctors guide by viewing magnified
High-TechHealingBy Lisa Collier Cool
Ashlynn Rice, 17, tried to be bravewhen she was rushed to the ICUin February with chest pain and
shortness of breath. She made jokes andtold her parents to go home for the night.But after they left, the eleventh-graderfrom Quakertown, Pa., was too tense tosleep. “At midnight, I heard a voice say,‘I’m watching over you.’ I thought it wasGod, then I looked up and saw a doctoron an overhead screen.”
Hospitals
I l l u s t r a t i o n s b y A l e x W i l l i a m s o n
THE WALL STREET JOURNAL. * * * * Saturday/Sunday, October 24 - 25, 2009 W7
Patient Safety Medical Accuracy Training Treatment Lowering Costs
Surgery is complicated enough.The last thing you need is complications.
At Covidien, our commitment to positive outcomes beginswith helping to ensure patients’ well-being in the hospital. In fact,our collaborations with medical professionals worldwide havealready yielded advances in patient safety, surgical proceduresand recovery times. To learn more about our positive benefitsin the healthcare industry, visit covidien.com/successstories.
Lisa Collier Cool has won 18 awards for medical journalismand is a past president of the American Society of Journalistsand Authors. Her articles have appeared in Self, Fitness andO, The Oprah Magazine.
Hospitals Go GreenSurgical scrubs aren’t all that’s green at America’s
medical centers. More than 25 percent of them havejoined Hospitals for a Healthy Environment, a govern-ment-supported initiative to lighten medicine’s eco-footprint. Among its goals are reducing waste, conserv-ing energy and water and eliminating mercury frommedical equipment, such as thermometers and bloodpressure cuffs.
But the movement isn’t just about protecting theplanet, says Sanford Smith, senior vice president ofreal estate and facilities at Hoag Hospital in NewportBeach, Calif. “Along with doing the obvious things,like improving recycling, we’re also trying to create aholistic environment that enhances healing by upgrad-ing patient comfort and safety.”
This includes a green renovation of Hoag’s Irvinefacility. “Indoor air quality is very important in a hos-pital, so we’re using materials and furniture with lowor no VOCs” — volatile organic compounds that emitpotentially harmful vapors — adds Smith. Hospitalrooms are also being reconfigured to increase naturaldaylight. “Not only does that save energy, but we be-lieve it makes people feel better.”
Hospitals are alsoserving healthier mealsfeaturing fresh, season-al fruits and vegetablesand antibiotic-free meat.Some also grow theirown herbs for flavoring,use napkins and paperplates that can be com-posted after use or evenhave beehives on the grounds for a summer honeyharvest. Another innovation is cooking food to or-der, so patients can eat when they’re actually hungry.Not only does that improve nutrition, since illness orsurgery can impair appetite, but it also cuts down onwaste.
Since Fletcher Allen Health Care, in Burlington, Vt.,instituted hotel-style room service, using organic foodfrom nearby suppliers, meal costs have dropped by 20percent. To combat the obesity epidemic and encour-age healthy eating, the hospital now has an on-prem-ises farmers market. Due to tastier meals, says DianeImrie, director, nutrition services, “patient satisfaction
ratings just hit an all-time high.”The eco-trend is also influencing how hospitals
scrub and disinfect. Healthcare facilities and schoolsnationwide participate in Greening the Cleaning, anonprofit line of eco-friendly cleansers. “The firstthing visitors notice is that the harsh chemical smellis gone,” says Deirdre Imus, who spearheaded the pro-gram at her Environmental Center for Pediatric Oncol-ogy at Hackensack University Medical Center, in NewJersey. “It’s just common sense that fresher air andreducing environmental toxins aid in healing.”
— L.C.C.
images of the body’s interior. Robotic surgery can beused for conditions as diverse as bladder cancer, coro-nary artery disease and gynecological disorders.
“Because this technique is so precise, there’s lessblood loss, reducing the need for transfusions,” saysJames Porter, M.D., director of surgical robotics. “Andpatients recover faster, with less pain.” Dr. Porterspeaks from first-hand experience. When he developedprostate cancer in 2006, at age 43, he was treated withrobotic surgery. “I was back at work in a week, withoutany complications. That made me even more of a be-liever in the benefits of this high-tech surgery.”
An Electronic Safety NetTo combat medication errors, healthcare facilities
are turning to “closed-loop” systems, with safeguardsat each step of the prescribing process. Here’s howit works at Overlook Hospital in Summit, N.J.: Doc-tors enter orders on computers that check the patient’schart for allergies and drug interactions, and verifythat the dosage is appropriate. The prescription is thentransmitted to a pharmacist who repeats the safetychecks and gives an electronic stamp of approval.
Drugs are stored in locked dispensing cabinets
on each floor. “The only drawer thatopens is the one with the patient’spills,” says Celeste Castle, R.N., man-ager of oncology and nursing informa-tion. “Nurses carry portable scannerson wireless smart carts and match thebarcode label on the medication to thepatient’s wristband. And all the lab re-sults are right at their fingertips on PCmonitors.”
Not only has the error rate droppedto less than one percent since the sys-tem was launched in 2006, but critically ill patientsare treated faster, Castle adds. “We used to run intoproblems with STAT (urgent) medications, which aresupposed to be given within 30 minutes, because themanual process took up to two hours. Now we have a15-minute turnaround, which is a huge improvementin patient safety.”
High-Tech TrainingA newly licensed nurse at Duke University Health
System, in Durham, N.C., found her patient unrespon-sive, with clammy skin, slow breathing and a rapidpulse. The patient went into cardiac arrest, requiringCPR. However, the “patient” wasn’t human; it was alife-sized medical manikin (the preferred spelling to
distinguish these high-tech devicesfrom department store mannequins).
Known as SimMan 3G, it cansimulate hundreds of medical con-ditions, allowing novice doctorsand nurses to safely practice patientcare. The highly realistic manikinsweats, breathes, vomits and evenbleeds. It also has a heartbeat andpulse, and reacts to over 350 medi-cations, to demonstrate potentialside effects and the warning signs
of an overdose. A female model named Noelle givesbirth to baby Hal.
During training sessions, says Pam Edwards, Ed.D.,R.N., associate chief nursing officer for education, “Youcan set up any scenario you want, including code situa-tions where resuscitation attempts succeed or fail, thendiscuss what went right or wrong. That helps recentlylicensed nurses and resident physicians recognize theiranxiety, learn from mistakes and be better prepared forreal-life emergencies, where every second counts tosave lives.”
