Paths to Improved Patient Care

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Efforts in education, collaboration, and technology are improving care coordination.

Care coordination and improving patient care are lofty goals for health leaders today. With better technology and greater health stakeholder interaction, better care can be achieved. The HealthLeaders Media online news team has examined how facilities are working to improve patient care and safety through technology, education programs, and staff interaction. Here are excerpts of articles written by Ben Cole and Julie McCoy.

MassGeneral Program Brings Remote Doctor to the Bedside 24/7
A "home-to-hospital" program in use at MassGeneral Hospital for Children uses real-time video communication that enables an on-call attending physician, from home, to personally examine patients and communicate directly with staff, other specialists, and even the patients' relatives.

Through the Connected Pediatric Critical Care program, six pediatric intensive care unit physicians from MassGeneral currently have the videoconferencing units in their homes.

"The physicians, nurses, and therapists at the bedside have felt better with the new system in place due to their ability to directly communicate with the attending physician, see him or her, and continue to do whatever is necessary to treat the patient while this communication is taking place," says Natan Noviski, MD, chief of pediatric critical care medicine at MassGeneral Hospital for Children. "The attending physicians at home feel that they actually can better help with the decision-making and management of the clinical scenario that triggered the call."

The new system includes a telemedicine station at the home of each senior attending physician covering the PICU at night, and a mobile cart, nicknamed the PICUBOT, that can be moved from bed to bed as needed.

Using the telemedicine system, the attending physician can then see the patient, talk with clinicians on site, personally evaluate the child's condition, and make treatment decisions. Special cameras and scopes can also be attached to the telemedicine station to allow for closer evaluation of the patient.

"From home, the attending MD uses a remote to control the camera located in the PICUBOT, which is stationed at the patient's bedside," Noviski said. "The team at the bedside can see the attending MD in the screen of the PICUBOT."

The system "allows for a multidisciplinary communication based on being able to see the critically ill child rather than a 'blind,' two-person-only conversation. This improved communication obviously benefits the patients as well," Noviski said.

The Connected Pediatric Critical Care program was launched at MassGeneral for Children in partnership with the Center for Connected Health—a division of Boston-based Partners HealthCare, an integrated health system founded by Brigham and Women's Hospital and Massachusetts General Hospital.

"Videoconferencing is not new, but the application of this technology—connecting at-home physicians with their patients and the hospital-based medical team—is a novel and important advance in critical care medicine," said Joseph C. Kvedar, MD, director of the Center for Connected Health, in a statement.

The program creates a teaching opportunity as well, allowing residents to be more involved in a team approach that benefits the care environment, proponents say. It can also help parents feel more confident about the attending physician because it gives them more of an opportunity to interact with the doctor.

Kvedar and Noviski added that other intensive care units, for both adults and pediatric patients, could benefit from similar home-to-hospital telemedicine systems.

"If successful, this program can be incorporated into all of the ICUs and patient floors," Noviski says.

Written by Ben Cole on February 8.

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