NEJM Catalyst Publication Features Mission Health Study
ASHEVILLE, N.C. (January 26, 2017) – Mission Health’s Center for Innovation and Neuro Trauma Unit eliminated patient falls, and the injuries typically associated with them, during a three-month pilot project using an innovative virtual observer system and clinical workflow redesign. This is an impressive accomplishment, as fall risk is a reality in all hospital settings and particularly so on a Neuro Trauma unit.
Though Mission Health has long employed standard fall risk prevention practices, the health system recorded 4.7 unassisted falls and 0.91 injuries in the same unit – or 5.74 total falls – per 1,000 patient-days of care in the 12-month baseline period of August, 2014-July, 2015. Mission Health and the study’s authors pursued creative solutions to the problem by employing effective complementary strategies of rethinking caregiver workflow patterns, experimenting with new technology through an innovative partnership with Cerner Corporation, and by assembling a multidisciplinary team to approach the problem.
The trial was jointly initiated and funded by Mission Health and Cerner Corporation, and overseen by Mission Health’s Center for Innovation, which works to advance and execute new tools and systems that improve healthcare at Mission Health and beyond. The 34-bed Neuro Trauma Unit has Mission’s highest historical patient fall rate due to the fact that its patient population consists of people who have neurologic disease and/or brain injuries. The unit’s talented Nursing Manager, Josh Lewis, RN, volunteered to be the clinical sponsor due to the positive impact the project could have on patient safety.
The authors focused on the fact that nationally hundreds of thousands of patient falls continue to occur annually in the United States, and of those, 30-50% result in patient injuries, despite multi-component fall preventive strategies for patient falls that is used by most hospitals, including Mission Health. And those fall-related injuries not only harm patients, but also lengthen hospital stays by an average of over six days and typically add $14,000 to the cost of each lengthened hospital stay.
For the three-month pilot term, a revolutionary “virtual sitter” technology owned by Cerner Corporation and called Cerner Patient Observer (CPO) was used in addition to traditional multi-component fall prevention strategies. The “virtual sitter” pilot consisted of six cameras deployed in patient rooms who were determined to have the highest risk of falls by a falls risk algorithm.
Cerner Corporation’s “virtual sitter” technology grew out of Microsoft® Kinect® technology, which employs a depth and motion sensor to visualize full-body, 3-D movement within a 20-foot range. The virtual sitter is an infrared camera, which not only has the capability to monitor a patient’s movements, but can also identify the zone that immediately surrounds the patient and potential risks, via application interface custom software programming. A live video feed is delivered to a high-definition monitor via a secure wireless network, so a clinician can monitor multiple patients from one location. Staff who monitor patients are alerted when patients cross the safety zone set by the monitoring clinician who also can remotely communicate with patients via two-way audio. The pilot’s success directly increased patient safety and also allowed caregivers to focus their energies more efficiently.
“Quality care is important to Mission, and innovation is part of how we make sure that we’re always moving that ball forward quickly, and we’re able to do that with Patient Observer,” said Jonathan Brown, Mission Health’s Chief Information Officer.
Ronald A. Paulus, MD, a study author and Mission Health’s President and CEO, notes that there are many other exciting applications for the CPO system across hospital departments, the health system’s member hospitals, at other health systems across the country, and in other care settings such as nursing homes and assisted living facilities. “If we can create something that works and solves problems for an organization like Mission, then it’s likely to help others across the industry as well,” said Dr. Paulus.
The technology could be used in the future in conjunction with virtual visitation programs currently being explored in the Mission Neonatal Intensive Care Unit to allow family to “visit” a baby even across great distances and preventing patients from leaving the hospital prematurely. The authors advise that success metrics be carefully defined, tracked, and analyzed when solutions such as the Cerner Patient Observer are studied.
Mission Health would like to thank Josh Lewis, RN; Robin Robinson, RN; Noelle Shepherd, CAN; Carrie Edgison RN; Project Manager Chad LaRowe; Mission Health’s IT team; and all the caregivers in the Neuro Trauma Unit for their participation, input, compassion and encouragement throughout the pilot project’s term. The success of this project has led Mission Health to host other highly respected health systems across the country as their representatives learn about the Neuro Trauma Unit’s innovative work in the arena of fall prevention.
About Mission Health
Mission Health, based in Asheville, North Carolina, is the state’s sixth-largest health system and was recognized as one of the nation’s Top 15 Health Systems from 2012-2015 by Truven Health Analytics, formerly Thomson Reuters, becoming the only health system in North Carolina to achieve this recognition. Mission Health operates six hospitals, numerous outpatient and surgery centers, post- acute care provider CarePartners, long-term acute care provider Asheville Specialty Hospital, and the region’s only dedicated Level II trauma center. With approximately 12,000 employees and 2,000 volunteers, Mission Health is dedicated to improving the health and wellness of the people of western North Carolina. For more information, please visit mission-health.org or @MissionHealthNC.