An evaluation of Sutter Health'seICU.

摘要

To improve patient safety and quality, hospitals are being encouraged to expand management of Intensive Care Unit (ICU) patients by specialists (intensivists). In 2002 the largest hospital network in Northern California, Sutter Health, initiated a remote ICU monitoring program (eICU). In this exploratory case study we address 3 specific aims: (1) to understand how the decision was made to adopt eICU and how organizational support for a significant change in ICU staffing and care processes was bui (2) to measure the level of clinicians' use of the eICU and factors affecting use at two hospitals; and (3) to explore the preliminary eICU impact on the quality of 8 ICU clinical processes before and after eICU implementation at the same two hospitals. In-depth interviews were conducted with management executives and clinicians of Sutter Health and the hospitals. Direct observations were made at the two hospitals and at the eICU. Finally, clinical process data were collected before and three months after the eICU implementation. We found that strong executive leadership, widespread belief in improving patient safety across Suffer Health and CPMC, and external demand for quality improvements made the eICU program possible. Barriers to change include the lack of (1) well translated and articulated value proposition for different levels across the health system, (2) support of physician leaders, and (3) medical informatics expertise. There was strong evidence that eICU extended the overall capacity of "moonlighting" physicians during high census by providing nurses and physicians immediate access to an intensivist during emergencies and provided a dedicated early detection and warning system for critically ill patients. We also found that the eICU has generated only a fraction of the potential quality benefits anticipated for it as a result of low level of use and acceptance by managing physicians of eICU resources. The eICU was not delegated the appropriate authority by the managing physicians to intervene in the more routine but important elements of ICU care such as the clinical quality processes targeted in this study. The study results indicate that substantial efforts at the system, eICU, and hospital levels will be necessary to achieve the potential value of this promising innovation.