By ECRI
As detailed in last month’s issue, a team from Boston Medical Center (Boston, Massachusetts) earned ECRI Institute’s 2018 Health Devices Achievement Award for its development of a mobile app that guides postsurgical patients through the pulmonary care protocol. That project was not the only one to gain recognition, however. ECRI Institute honored five additional groups as finalists for the 2018 Award. The projects from these organizations – described below in alphabetical order – demonstrate the innovative ways that ECRI Institute member organizations are improving patient safety, reducing costs or otherwise facilitating better strategic management of health technology.
Boston Medical Center
In addition to the winning initiative, a second Boston Medical Center project was judged to be one of the year’s top submissions. That project team implemented an early warning system (EWS) to reduce clinical deterioration and preventable death among hospitalized patients.
The warning system leverages the capabilities of the electronic medical record to (1) identify clinically decompensating patients through the capture and analysis of rapidly changing patient physiologic and laboratory variables, (2) alert frontline clinicians when a patient’s condition is beginning to deteriorate, and (3) trigger interventions from critical-care-trained nurses who can implement measures to prevent further clinical deterioration and reduce preventable mortality.
The Boston Medical Center team determined that for an EWS to be effective, the health care facility first must select clinical variables and thresholds that will accurately reflect clinical deterioration in the facility’s specific patient population. Then, the facility must reliably and swiftly direct appropriate clinical resources toward decompensating patients. The organization configured its EWS to trigger a standardized response protocol, activating a multidisciplinary response team to attend to affected patients.
A retrospective comparison of cases suggests that the efforts have led to reductions in the length of stay, the number of ICU transfers, the time to resuscitative efforts and unexpected mortality.
Einstein Healthcare Network
Researchers at Einstein Healthcare Network (Philadelphia, Pennsylvania) studied ways to reduce IV contrast extravasations that occur during contrast-enhanced computed tomography (CT) examinations. Specifically, researchers assessed whether injecting a test bolus of saline using a power injector, instead of injecting it by hand, can decrease the number of subsequent IV contrast extravasations that occur.
Previously, a pre-contrast test bolus of normal saline was injected by hand for most examinations. If no extravasation was observed, the iodinated contrast would be injected using a power injector. The team hypothesized that using a power injector to also deliver the test bolus, rather than injecting it by hand, would more closely reproduce the force and pressure of the iodinated contrast injection. This, they reasoned, would provide a more reliable assessment of the viability of the IV injection prior to administering IV iodinated contrast.
To test this hypothesis, Einstein instituted a new protocol specifying that the saline test bolus be power-injected for all IV-contrast-enhanced studies. The team then compared extravasation rates for the periods before and after the change. The review of data from more than 34,000 exams showed that the intervention reduced extravasation rates by 54 percent.
St. Luke’s Medical Center, Philippines
A program that helped a hospital in the Philippines overcome local challenges to obtaining original equipment manufacturer (OEM) supplies earned recognition for St. Luke’s Medical Center (Quezon City, Metro Manila). Faced with delivery delays of up to a few months for some medical equipment accessories, the St. Luke’s clinical engineering team instituted a program to identify and evaluate third-party alternatives to certain OEM products.
OEMs dominate the market for medical equipment accessories in the Philippines, yet their distribution channels in the region are not always extensive enough, and their local inventory of supplies is not always large enough, to meet demand in a timely manner. In the absence of trusted third-party alternatives, health care facilities may have to wait for OEM products to become available.
Rather than accepting the status quo, the St. Luke’s team instituted a process for finding functionally equivalent products for several types of medical device accessories that require frequent replacement. The program focused on ECG cables, pulse oximetry sensors, batteries and a handful of other products. Over four years, the program achieved savings of more than PHP8,348,350 ($160,000).
VA Healthcare Technology Management Program Office
To effectively respond to cybersecurity threats, a health care organization must be able to quickly retrieve technical attribute information for the medical devices that are connected to its network. For a large, national organization like the U.S. Department of Veterans Affairs (VA), recording and retrieving this information can be a tall order. In fact, the organization did not have a standardized or centralized means for doing so, relying instead on individual biomedical engineering departments to develop their own approaches for maintaining inventory listings.
To address that shortcoming, the VA National Healthcare Technology Management (HTM) Program Office (Bedford, Masachusetts) developed and deployed its own application. The resulting solution – named the Networked Medical Device Database – was developed by VA biomedical engineers using only existing resources. The only direct cost for the project was for the engineers’ time.
The database provides central access to data about network-connected medical devices across the VA. As such, it allows the HTM Program Office to monitor several key performance indicators nationally to verify that the inventory data is accurate. In addition, the database enhances vulnerability management and other medical device security activities across all VA medical centers.
Veterans Health Administration
Upon learning that a particular blood glucose monitor (BGM) model had been associated with treatment errors – one of them fatal – researchers representing several U.S. Department of Veterans Affairs (VA) Veterans Health Administration (VHA) organizations established a rigorous process for investigating the cause of the errors and recommending corrective actions. Because that same model of BGM is used in many VHA facilities, guidance to prevent adverse events would have far-reaching patient safety implications.
The team identified that certain results screen configurations on the BGM were prone to being misinterpreted. The team researched possible solutions, then tested the various alternatives to identify a configuration that minimized the risk of future adverse events.
To put its findings into action, the VHA team developed configuration recommendations for this BGM model, communicated its recommendations throughout the VHA, and discussed the findings with FDA and the device’s manufacturer. The manufacturer has already released a firmware upgrade that addresses some of the issues raised by the VHA study.
ECRI Institute honored representatives from the VA Pittsburgh Healthcare System (VAPHS), the VA National Center for Patient Safety (NCPS) and the VA Hudson Valley Health Care System (VAHVHCS) for their collective efforts.
Also Deserving Recognition . . .
Next year, the winner could be you. ECRI Institute presents its annual Health Devices Achievement Award to the member health care institution that has carried out the most exceptional initiative to improve patient safety, reduce costs or otherwise facilitate better strategic management of health technology.
If your organization has engaged in a health technology management project that deserves recognition, ECRI Institute wants to hear about it. The nonprofit research institute will be accepting submissions for next year’s Award from October through January. For additional information, visit https://www.ecri.org/Pages/Health-Devices-Award-Rules.aspx.
This article was excerpted from ECRI Institute’s membership website. The full article features additional details about the projects outlined above.
For more information, visit www.ecri.org/HDAwardwinner; or e-mail communications@ecri.org.
