ICU Care Coordination Platform

Helping critical care teams recognize recovery sooner and take timely action

Opportunity

Approximately 5 percent of hospitalized patients end up in intensive care units (ICUs), accounting for 20 percent of overall hospital care costs.  

ICUs are charged with caring for the sickest patients. The care required is complex, fast-paced, and necessitates streamlined cross-disciplinary collaboration. In a chaotic care environment where staff is inundated with data, it is often difficult to recognize when patients are ready to progress along care processes - such as being weaned off of mechanical ventilation. 

Approximately 30 to 40 percent of ICU patients are on a ventilator for the majority of their stay. Every extra day on a ventilator can lead to a longer length of stay (LOS) for patients, as well as increased morbidity and mortality. 

Intervention

The ICU Care Coordination Platform is an automated digital platform designed to monitor the status of ICU patients in real-time and prompt providers when action is needed – for example, when a patient is ready to come off mechanical ventilation.

In a single view, providers can see ventilation and sedation status for all of their patients - enabling them to discuss care decisions before and during rounds. A custom algorithm, developed by Penn Medicine’s Data Science team that includes more than 20 clinical data parameters, pinpoints when patients are ready to come off mechanical ventilation. When a patient presents such a need, secure text messages are sent to clinicians alerting them to take action.

Impact

The ICU Care Coordination Platform prevents delays and missed opportunities in ICU care, enabling better patient outcomes, increased hospital capacity, and reduced health care costs.

In a pilot in the medical intensive care unit (MICU) at the Hospital of the University of Pennsylvania (HUP) with more than 140 mechanically ventilated patients, patients enrolled in the pilot awoke and came off the ventilator sooner. We also saw a decrease in median ICU LOS by 1.1 days and median overall hospital LOS by 1.5 days. For patients, this led to lower morbidity rates and expedited recovery after hospitalization.

Based on the pilot's success, we partnered with Data Science, Information Services, the eICU team, Penn Value Improvement, and the Critical Care Committee to expand use of the platform to every ICU in the health system. Care teams currently utilize the ICU Care Coordination Platform at HUP, Pennsylvania Hospital, Penn Presbyterian Medical Center, and Chester County Hospital.

The ICU Care Coordination Platform is estimated to produce a cost savings of approximately $3 million per year for the health system. In addition, the capacity created by the platform translates to adding five ICU beds per year.

Beyond vent weaning, the platform has also been used to support the risk reduction and management of acute respiratory distress syndrome and has the potential to be used for other ICU care processes.

Phase 3: How we work
Collaborators

Barry Fuchs, MD
Penn Medicine Data Science team
Penn Medicine Information Services
Penn Medicine eICU team
Penn Value Improvement

Innovation leads

Katherine Choi, MD
Eugene Gitelman, MD
Damien Leri, MS.Ed, MPH
David Do, MD
Shivan Mehta, MD, MBA, MSHP

Platforms
Funding

Innovation Accelerator Program

Awards

UPHS Quality and Patient Safety Award, 2017

Innovation Methods

Show me

Instead of relying on a verbal recount of experience, ask users to show you how they use a product or service. What people say they do is often quite different than what they do.

Observing users in action will help you understand the spectrum of experiences users can have with the same product or service.

Surveys, interviews, questionnaires, and focus groups don’t tell you what you need to know. Prompting users to show instead of tell often reveals what others have missed.

Show me
Our team spent hours rounding with the ICU teams, seeing how alerts impacted cascading next steps. This process uncovered the need for more contextual data to help providers make decisions and collaborate across roles. That led to a dashboard view of all patients in the unit, which underwent daily to weekly iterations informed by how providers used the tool on the frontlines.
 
Eventually, dedicated “ICU board rounds” were conducted daily to facilitate coordinated care for these patients.

Videos

Pitch Day 2017