Sharp's Gross says that in his new hospital, bathroom entryways are not only wider, but their doors also slide open instead of swing. "Traditional swing-out doors are difficult for a patient with a walker, or who is trying to pull an IV pole—it just adds to their risk for a fall," Gross says.
Reducing medical errors: Inexpensive design changes that reduce noise—perhaps through the installation of acoustic ceiling tiles—can not only reduce staff mistakes, but they can also make it easier for patients to relax and sleep, which hastens their recovery, according to studies published by the Center for Health Design in conjunction with the Georgia Tech University and Texas A&M University Colleges of Architecture.
Acuity adaptability: This buzz phrase means the room can be easily converted for a patient requiring more intense care, avoiding hand-off errors that occur when patients have to be moved from room to room. Adding telemetry monitoring in patient rooms is an inexpensive way to accomplish this.
Reducing worker injury: Installing electronic patient lifts in each room can prevent staff injuries, which by one estimate affect 38% of all nurses in the United States.
5. The telemedicine game changer
If telemedicine is not part of your long-term strategy, it should be. An aging population, aging workforce, and a physician shortage offer a triple-whammy of potentially negative trends that telemedicine can help solve. All of these factors are making it more difficult for patients to access the healthcare services they need. That's why Avera is making telehealth a key strategic initiative, says David Erickson, MD, chief medical officer for the 28-hospital health system based in Sioux Falls, SD. Avera has an e-ICU program that's been operational for five years—it currently has 75 beds wired. It also has e-emergency services at eight sites and e-pharmacy services at six sites, and it launched a telestroke program in December.
The healthcare industry is just starting to see how critical this form of care delivery will be in the next five to 10 years, he says. For example, a patient who has a stroke in a rural town can be treated at the local emergency department by a remote neurologist, who can review blood work and CT scans to determine if the patient is a candidate for thrombolytic therapy. Medications can be reviewed at the e-pharmacy and the patient can be admitted to the e-ICU and monitored 24-hours a day.
"Those rural providers can get some sleep," says Erickson. If physicians are up day and night for several days, it can take a toll, he says. "Eventually they decide to leave to go where the call schedule is easier to handle."
The technology is now able to provide reliable, high-quality, and high-speed interactions, as well. Not only are clinicians becoming comfortable with this form of workflow and communication, but patients are becoming accepting of it, as well. "Traditionally, patient acceptance of telemedicine would be 60% versus 90% for a face-to-face visit," says Kaveh Safavi, MD, vice president and global lead for Cisco Systems' healthcare practice. But now the quality of the interaction is so good that patient satisfaction with remote visits is equal to or better than face-to-face visits, he says. "You are no longer looking at telemedicine just as a way to care for the underserved, but talking about telemedicine as an alternative for the already served."
About 80% of healthcare costs in the United States can be attributed to chronic diseases. "We are now looking at technology as an enabler to build solutions that can help us better monitor patients suffering from these chronic conditions," says Sean Chai, senior technology manager at Kaiser Permanente's Garfield Health Care Innovation Center. Organizations are turning to videoconferencing and telemonitoring technology to stay more connected with patients. "With the rapid proliferation of healthcare monitoring technology, this market is predicted to be a $7.5 billion market in less than five to10 years," Chai says.
Obstacles in cost and reimbursement have slowed the widespread adoption of telemedicine. Providers receive some reimbursement for their e-consultations, but they don't receive additional reimbursement for an e-ICU or telestroke program. "We don't get any additional payments for the work we do, but I'd challenge that our outcomes in our e-ICU are the best of the best across the country," says Erickson. "Our mortality rate is down, length of stay is down, ventilator days is down, and we don't receive any quality payment for that—just standard fare."
Both Erickson and Safavi expect the reimbursement issue to be addressed sooner rather than later. "To maintain care in many rural and frontier sites, we are going to have to change the reimbursement system," says Erickson, who expects some progress to be made in the next couple of years. There are some issues around licensure and state laws about the practice of medicine that will need to be addressed, as well, says Safavi, who is confident they will be resolved.