Virtual Nurses in a Virtual ICU?

If you want to know what the ICU of the future will be like, think of an extremely ill patient connected to myriad tubes and monitors; watched by cameras; every sigh, snore, or change in breath sound picked up by an audio feed.

Then remove the patient, leaving just monitors, speakers, and video screens.

The ICU—or virtual ICU (vICU, also sometimes called eICU)—may be hundreds of miles away from the patients, located in an office building like any other, with nurses and physicians seated in front of banks of flat-panel screens, monitoring patients from a number of facilities or across a large hospital system.

In a session presented at the American Association of Critical-Care Nurses National Teaching Institute in New Orleans last week, Margie Fortino, MSN, RN, operations director of the Penn E-lert eICU at the University of Pennsylvania Health System, explained how vICUs (or eICUs) are being used not only to bring the resources and expert care of experienced specialists to rural facilities, but also in large medical centers to increase safe outcomes. The premise is that “an extra pair of eyes”—even though they may be many miles away—can catch patient problems earlier, especially during shifts where staffing may be leaner.

Fortino noted that a vICU nurse may watch 40 screens—more on the night shift—and use live audio and video to “assess” a patient when something triggers an alarm. The nurse can then alert the actual hospital nurse responsible for the patient. Often, a physician will also work the night shift in a vICU, acting as the “on-call” physician available to diagnose and order medical interventions—which are then implemented by the bedside health care providers. Initial data show promising results, with earlier interventions leading to decreased length of stay in ICU and reduced costs. Impressive, to be sure.

This technology may allow nurses who may not be able to physically work at the bedside to continue to use their knowledge and experience. And I’m all for technology that increases safety in health care.

But I can’t help wondering: wouldn’t better nurse-staffing ratios also provide that “extra pair of eyes”? How much money spent on the new technologies hailed in many health care reform plans could be spent providing adequate staffing? We already have plenty of data showing that increasing nurse staffing leads to better patient outcomes. When will people get excited about solving the problems that are right in front of them?

Copyright American Journal of Nursing Tuesday 20th October 2009 09:40

Source: http://ajnoffthecharts.wordpress.com/2009/05/22/virtual-nurses-in-a-virtual-icu-will-technology-trump-staffing/

Nurses calling for safer staffing

Four out of 10 nurses say staff shortages compromise patient care at least once a week, according to the Royal College of Nurses. An RCN manifesto to all the political parties says NHS employers must assure themselves they have safe staff levels. The RCN, whose survey covers the views of 9,000 nurses, is warning against job cuts due to possible reduced funding. NHS trusts said managers were increasingly examining their workforces to best use the skills of their staff.

The RCN has issued its 2009 Employment Survey which covers the views of 9,000 nurses. It shows that more than half (55%) say they are too busy to provide the level of care they would like. Almost two thirds (67%) consider their workload is too heavy. And nurses say they are looking after more patients on the wards.

Dr Peter Carter, head of the RCN, said staff were concerned that they were delivering the basics but were unable to provide the full range of quality care they would like. He said: "Nurses and healthcare assistants feel up against it, worn down and exhausted by the pressure to make efficiencies and frustrated by being prevented from delivering the quality of care they want to be providing."

The RCN are also warning of a shortfall in the number of nurses in coming years. The RCN's Labour Market Review said about 200,000 nurses are expected to retire in the next 10 years, there will be fewer newly qualified nurses and fewer nurses moving to the UK because of restrictions on migration. The RCN says the impact of growing retirements from the profession will be felt first in the community sector where most of the nurses tend to be older.

Dr Carter said: "The nursing workforce has grown in recent years but only just enough to keep up with rising demands on healthcare. "We expect the next few years will be the most challenging for staff levels in decades. "There is considerable pressure to focus on short-term funding constraints and cut staff numbers without taking patient needs into consideration. "Policy makers must look at the workforce in conjunction with their ability to deliver high quality and safe care."

Karen Charman, head of employment services at NHS Employers which represents trusts in England, said NHS organisations certainly needed to have a clear method of working out safe staffing levels in order that patient care was not harmed. "There are a number of different ways of achieving this and we believe that this should be determined at local level," she said. "Advice from professional bodies is extremely important to help trusts ensure that clinical standards and staffing levels are right to ensure the safety of patients. "However, fixed staffing ratios do not provide the flexibility to meet differing local circumstances and care settings "Employers are increasingly examining the different roles within their workforce to best use the skills of their staff."

Copyright BBC Health News, Tuesday 20th October 2009, 09:35

Source: http://news.bbc.co.uk/1/hi/health/8310766.stm

Specialist paediatric heart units face closure

Up to five units which currently provide major surgery to sick infants born with congenital heart problems will be ordered to shut down or merge with larger units after new safety standards are published this week.

The smallest units – in Oxford, Leicester, Southampton, Newcastle, Bristol and Leeds – face the greatest threat of closure, though Government sources said no decisions on individual services have yet been taken. The president of the Society for Cardiothoracic Surgery (SCTS) said just "six or seven" of the current 11 units would be retained.
 
Recommendations to set such standards were made eight years ago, as part of a damning public inquiry into the deaths of dozens of babies and children at Bristol Royal Infirmary at the hands of surgeons with insufficient experience of complex surgery.

Last night charities and parents groups said they were frustrated by the amount of time it had taken to agree plans which will require a total reorganisation of the service. They urged politicians not to delay further in making controversial changes, which are likely to be fiercely fought once decisions on individual units are taken. The recommendations stem from an "urgent" review of children's heart surgery ordered by the Department of Health last year.

Leslie Hamilton, president of the SCTS and a member of the steering group which carried out the review, said the impact of their proposals would be to reduce the number of centres in England by about half. He said: "The units that exist across the country now are there because of sheer hard work, but they have always been a bit too small, and somewhat under-resourced. "There have been major changes in treatment of congenital heart disease – there is nothing now we can't tackle, but that means there is a need for bigger centres which can meet the physical demands of surgery, 24 hours a day, and have the right specialists available."

Cardiac surgery had become increasingly specialist, he said, but no surgeon could be expert in many areas at once. Currently, many surgeons were still carrying out operations in which they had little experience, he said.

He gave the example of the condition Hypoplastic Left Heart Syndrome, an underdevelopment of the heart, which is suffered by just 50 to 70 babies born in the UK each year. "In the past there was nothing we could do about that; now we can operate. But if every unit tries to do it, their surgeons are only doing five or so cases a year. It is not in anyone's interest to be doing so few," he said.

On Thursday, the report by the NHS Specialised Commissioning Group will recommend that surgical teams carry out at least 500 heart operations on children a year, with at least four, and preferably five surgeons at each unit, he said. Meeting the standards would reduce the total number of sites to six or seven.

Anne Keatley-Clarke, chief executive of the Children's Heart Federation, a charity made up of 22 specialist support groups, said: "Most parents whose children need open heart surgery are prepared to travel a long way to get the best. "We have known for a long time that the current system is not sustainable, and that we need fewer centres for surgeons to maintain their skill level".

While such operations would be a "once in a lifetime" experience for most families, parents wanted to ensure that regular follow-up care and monitoring remained available locally, she said.

A poll of 1,000 parents of children who have had heart surgery found 73 per cent wanted to see the number of centres reduced.

Mrs Keatley-Clarke said she was worried that politicians were frightened of tackling the problem, in case it was unpopular with those who believed it was being done to save money. In fact, the changes were urgent, for reasons of safety, she said. "At the moment our helpline gets calls from parents because their child's operation has been cancelled three or four times, because there isn't enough intensive care backup," she said.

The federation will write to health secretary Andy Burnham this week, asking him to prioritise changes which could bring political difficulties. The removal of specialist services could have a knock-on effect, threatening the viability of routine hospital services more regularly used by local populations.

The largest specialist paediatric heart surgery units, at Great Ormond Street and Royal Brompton Hospital in London, and Birmingham Children's Hospital, currently carry out more than 400 operations a year. Alder Hey Hospital in Liverpool and Evelina Hospital, part of Guys and St Thomas' Foundation trust in London, carry out between 350 and 400.

The threat of closure looms largest over units at John Radcliffe Hospital in Oxford, and Glenfield Hospital in Leicester, which both carry out fewer than 140 operations a year and at Southampton General Hospital, which carries out 230 operations. Bristol Royal Infirmary's unit, which does 285 procedures a year, is also vulnerable. In the North, Leeds General Infirmary and Freeman Hospital in Newcastle, which both currently do about 290 procedures, are likely to compete to stay open. However, the Department of Health group carrying out the review has yet to establish which hospitals could take on a major expansion of their services, or to carry out analysis of transport links across England, which may favour some hospitals over others.

Copyright The Sunday Telegraph, London (UK), Tuesday 20th October 2009 09:27

Source: http://www.telegraph.co.uk/health/healthnews/6359356/Half-of-specialist-heart-units-for-children-face-closure-under-radical-Government-plans.html

Egg screening 'ups IVF success'

A screening technique can double the chance of IVF success, giving hope to tens of thousands of women struggling to have children, say experts. Doctors at an annual US fertility meeting heard for the second year running of the merits of a test that screens embryos for genetic faults. So far more than 20 babies have been born using the technique. The UK researchers say they are now able to back the method with "great confidence". They hope it will eventually be available to all. Currently, it is offered in a few private UK clinics.

Doctors believe the £2,000 test, called comparative genomic hybridisation or CGH, will be particularly useful to older women, whose embryos have a greater risk of carrying genetic errors that cause conditions like Down's syndrome. The screening checks chromosomes in the developing embryo when it is a few days old, meaning only those embryos with the best chance of success are used in fertility treatment.

Dr Dagan Wells from Oxford University, who led the study, described the latest results on 115 women - six times as many as last year - as "astonishing". The results are particularly impressive as many of the women were on their "last chance" at IVF - they were typically aged 39 with two failed IVF cycles behind them. In total, 66% of the women fell pregnant after screening - more than double the number (28%) who typically fall pregnant without it.

Dr Wells told the American Society of Reproductive Medicine's annual conference: "We were taken aback by the impact it had on the success rates. "I think it's at the point now that we can say with great confidence that we are seeing a positive effect of this."

Around 37,00 women undergo IVF every year in the UK and less than one in four of these procedures is successful.

Allan Pacey of the British Fertility Society said: "Embryology is really crying out for something like this. "We really haven't moved on from the science of just looking down the microscope and seeing if an embryo looks good on the basis of some rather loose criteria."

Susan Seenan, from Infertility Network UK, said: "We welcome all new research which may ultimately improve the success rates of IVF for patients. "Although this is still in very early stages, it could be of great benefit to older women whose chances of success with IVF treatment is lower and it is also welcome given the move towards single embryo transfer in the UK and the lack of NHS funding which often, unfairly, means that patients are being denied access to the three cycles which the NICE guidance recommended in 2004. "Improvements in success rates are always important but even more so where patients are receiving only one, or in some cases, no NHS cycles, and we look forward to seeing if further research confirms these results."

Copyright BBC Health News Tuesday 20th October 2009 09:24

Source: http://news.bbc.co.uk/1/hi/health/8313822.stm

Former nurses urged to re-register

A possible shortage of nurses and midwives caused by another swine flu outbreak has prompted the Scottish government to offer to pay former nurses £100 to re-register.

The money would cover the £76 registration fee and £23 cost of a disclosure check.

The Nursing and Midwifery Council has already written to 9,500 former nurses whose registrations have lapsed in the last four years, urging them to renew them.

Health secretary Nicola Sturgeon said: “We are continuing to work closely with boards and other organisations to ensure Scotland is prepared for any NHS staffing implications as a result of the pandemic.

“The extra resource former nurses and midwives can provide if the pandemic worsens will be vital, and that is why we are offering to meet any costs that re-registering will incur.”

Labour health spokesman Dr Richard Simpson said a second wave of swine flu could see GPs dealing with more than 5,000 extra cases a week. He said ministers must “step up their preparations”.

Source: http://www.hsj.co.uk/news/primary-care/swine-flu-former-nurses-urged-to-re-register/5006992.article
Copyright Health Service Journal Monday 5th October 2009

Chief executive of NHS urges AHPs to restructure the way care is delivered to patients

Allied health professionals have been urged to ‘simultaneously improve quality and productivity’ in order to meet the massive financial challenges currently facing the NHS.

Speaking at the Chief Health Professions Officer’s conference 2009, held in London on 6 and 7 October, David Nicholson, chief executive of the NHS, told AHPs that the scale of the challenge is to grow the NHS by 11 per cent over the next two years, without receiving any further funding from government.

Referring to Lord Darzi’s Next Stage Review, Mr Nicholson said: ‘We knew that, having been through 10 years where the NHS grew by a third or more, growth rates would become slower’. But he was keen to stress that ‘this is not about taking money away, but about using the money we have better’.

A whole series of drivers, including demographics, new technologies, and National Institute for Health and Clinical Excellence (NICE) recommendations, will put increased pressure on the system, adding up to a shortfall of around £15-20 billion, he said. The big challenge is to recycle this within the system.

Despite making ‘the strongest case possible’ to government for more money, he said, ‘we know the cash is not there’. One option to deal with the challenge is for ‘slash and burn’, or arbitrary freezes, but ‘we know that this does not work and affects different parts of the service in an unplanned and unmanaged way’, he pointed out.

The biggest contribution to saving money and recycling it around the system will be the way AHPs restructure the way care is delivered to patients, he concluded. ‘Look at the evidence for productivity gains, they are all at the interfaces between services, in the places where patients get a “raw deal” with duplication,’ he declared.

‘Transforming services in those areas are key to unlocking quality of services and reducing costs.’

Admitting that this is not something that can be done from the top down, Mr Nicholson said the critical issue is leadership. ‘It requires people like you to accept the challenge’.

Source: http://www.cot.org.uk/homepage/news/?l=l&ListItemID=1078&ListGroupID=261
Copyright College of Occupational Therapists, Thursday 8th October 2009

Twitter could provide 'innovative solutions' for long-term conditions

Research by a Bournemouth University web professional suggests that social networking website Twitter could be an effective means of delivering improved quality of life to people suffering from long-term conditions.

The research, which looked at blogging and microblogging among practitioners, patients, and support groups has identified Twitter as a possible means of improving the personalised nature of health care delivery and support.

Author Andy Pulman, from Bournemouth University’s School of Health & Social Care, said that Twitter “could cultivate and inspire private, focused group conversations between people with chronic conditions and offer an effective targeted information channel for practitioners”.

Speaking about his paper, Pulman said: “Twitter has evolved beyond its basic functionality to provide a variety of alternate uses, some of which are health-related and which might offer opportunities in relation to improving health. I feel that the internet, mobile technology and web applications like Twitter are ideal candidates for providing innovative solutions to help deliver improved health-related quality of life. My ongoing research in this area aims to find out if this is the case.”

For more information on Twitter, please visit our Twitter page at http://www.twitter.com/OESHealthcare

Source: http://www.nursingtimes.net/nursing-practice-clinical-research/long-term-conditions/twitter-could-provide-innovative-solutions-for-long-term-conditions/5007223.article
Copyright Nursing Times, Sunday 11th October 2009

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Time to get tougher on obesity?

Private clinics face safety check