How Resurrection Health Care implemented a 24/7 specialized care system via centralized remote patient monitoring by intensivists that has reduced medical errors and ICU mortality, improved patient outcomes, saved costs plus enabled tracking of patient vital trends.

1. Transforming Health Care Delivery through System Integration of the Resurrection eICU ® Program Becky Rufo DNSc RN CCRN Resurrection eICU Program Operations Director Resurrection Health Care, Chicago Insert logo I DO NOT have any significant financial relationships that create, or may be perceived as creating, a conflict related to this educational activity. eICU ® is a registered trademark of Phillips-VISICU © 2010 Resurrection Health Care

5. © 2010 Resurrection Health Care

6. More eyes, ears, enhanced care © 2010 Resurrection Health Care

8. © 2010 Resurrection Health Care

10. © 2010 Resurrection Health Care

12. © 2010 Resurrection Health Care

16. Integration Information Service New Care Delivery Model - Onsite and Remote Teams © 2010 Resurrection Health Care Respiratory Therapists & Dietitians Cardiac Rehab Residents & Attending Physicians Nurses & Student Nurses Physicians Pharmacy ICU Managers / Directors Marketing Medical Records Dept. / Coder Finance Department Risk / Claims / Legal Case Managers / Social Workers Executive Leadership Team Quality Department ICU

17. Fast Track to Integration and Performance Driving forces to Integration IS and Clinical Partnership APACHE/Benchmark Reports Evidence-Based Practice Clinical Resource Standardization Clinical Risk Reduction Multidisciplinary Collaboration Balanced Scorecard National Recognition Organizational and Executive Leadership Direction Integration Model Leveraging Innovation © 2010 Resurrection Health Care

20. Impact of Integration Clinical skills Critical Thinking Efficiency Energized Positive Empowered © 2010 Resurrection Health Care Patient Safety/Quality Retention Clinical Risk Reduction Standardization Best Practice Documentation

22. © 2010 Resurrection Health Care Consistent system ICUs mortality/LOS ratios< 1.0 0.52 reduction in ICU mortality. LTACH 8 Bed ICU (first 4 months). (*) ICU metric $1250/day saved in labor & supply costs. Non-ICU metric $300/day saved in labor & supply costs. $72 K additional revenue $387 K 50% LOS reduction. 3% reduction in unplanned discharges. Highest RHC APACHE scores (73-78). 2007-2009 Data ICU Days Saved 9,241 $ 11.5 M * Non-ICU Days Saved 18,517 $ 5.60 M * Lives Saved 1090 Unit Stays 20,175 APACHE Scores 57.4 - 59.5

24. Best Practice Compliance: Q2 2009 © 2010 Resurrection Health Care Measure Metric Target Q109 Q209 Q309 Q409 All e ICU Program Average: Q109 VTE Prophylaxis Compliance for At Risk patients > 90% 80-90% < 80% Stress Ulcer Prophylaxis Compliance for At Risk patients > 90% 80-90% < 80% Low Tidal Volume Ventilation Compliance for ALI/ARDS patients > 75% 50-75% < 50% Blood Transfusion Threshold Transfused PRBCs (hemoglobin < 7gm/dL) > 50% 20-50% < 20% Beta Blocker Use Compliance for at risk surgical & ACS patients >80% 60-80% <60% Glycemic Control Average daily glucose < 150 mg/dL > 80% 60-80% < 60% Complications Incidence of Acute Renal Injury / patient stay < 1.3% 1.3-1.6% > 1.6% Ventilator Days Median ventilator days < 1.5 1.5-2.0 > 2.0

25. eICU ® -ICU ICU turnover Reviewed quarterly Quality: APACHE Report RHC Quality Scorecard Data Balanced Scorecard Monitors system wide trends Drives clinical best practice Vision and organizational direction Quality :Benchmark Reports eICU ® MD Interventions © 2010 Resurrection Health Care

27. © 2010 Resurrection Health Care

28. Longitudinal Mortality *APACHE IV predictions begin © 2010 Resurrection Health Care

29. Longitudinal Length of Stay * APACHE IV predictions begin © 2010 Resurrection Health Care

33. National Safety Imperative - IHI - JCAHO National Patient Safety Goals - CMS 2008 Complication Proposal - Health Care Reform, “Stimulus Proposal” - HIMSS - ATA - ACCP © 2010 Resurrection Health Care

44. © 2010 Resurrection Health Care Resurrection System Key Metrics 24% 34% 40% 61% 81% 79% 90% 93% 2006 2007 2008 YTD 2009 Conversion Rate Timely Referral Rate

45. © 2010 Resurrection Health Care

46. Nursing Empowerment © 2010 Resurrection Health Care eICU Nurse Role definition Scope of practice Critical synthesis Leadership Role Model/Mentor ICU Nurse Resources Partnership Critical thinking Availability of data Nursing Students Clinical Rotation Role model Leadership Nursing Leadership Accountability IS/Clinical partnership

48. Institute of Medicine (IOM) Statements on Quality Patient Safety And Quality Information systems, Data standards, National infrastructure are key to improving Patient safety © 2010 Resurrection Health Care To Err is Human (2000) Crossing the Quality Chasm (2001) Patient Safety, Achieving A New Standard of Care (2003)

50. So…What’s it like to the Operations Director? © 2010 Resurrection Health Care

51. © 2010 Resurrection Health Care

53. RHC eICU ® Program 2008 and 2009 IMPACT award recipient NextGenWeb.org © 2010 Resurrection Health Care

54. © 2010 Resurrection Health Care

56. “ The names of the patients whose lives we save can never be know. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and wedding they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been.” ~Donald M. Berwick, M.D. © 2010 Resurrection Health Care

57. “ The names of the patients whose lives we save can never be know. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and wedding they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been.” ~Donald M. Berwick, M.D. © 2010 Resurrection Health Care

58. © 2010 Resurrection Health Care Feel free to contact me: Rebecca Rufo DNSc RN CCRN Resurrection eICU Operations Director Resurrection Health Care [email_address]