Children's Hospitals Today - Winter 2018 - 13

FROM EXPERIENCE / ROUNDS

paramedics to obtain venous
access and assist the care
team with intra-hospital patient transport.

HOW IT WORKS
At check in, parents and
guardians are informed of
the system with a statement incorporated into the
consent paperwork. They
are also informed the system is activated if an alarm
is triggered that indicates
potential risk to their child.
Paramedics view patients'
vital signs on computers at
their workstations and on
large video screens in the
CLC. When an alarm alerts
paramedics a vital sign is
outside the age-specific
normal range, the system
instructs the paramedics
on specific protocols and actions to take.
If a patient's oxygen saturation of the blood drops
below 90 percent, the system directs the paramedic
to communicate using the
audio system in the patient's
room, establish direct visualization of the patient
via camera, and establish
the absence or presence of
a health care provider. If
no team members verbally
acknowledge they are with
the patient, the paramedic
establishes contact with the
patient's assigned nurse. If
the patient's condition requires the paramedic to take
action, like if the patient is
in respiratory distress, the
paramedic activates a rapid
response team.
Paramedics in the CLC can
also establish audiovisual

communication with patients during a code blue.
The resuscitation leader
can use the CLC to contact
the attending physician or a
subspecialist to come to the
bedside. The paramedic can
text a nearby nurse if the
patient's nurse is occupied,
call the nurses' station and
ask the unit clerk to perform
a task, or call the charge
nurse to discuss the patient's
alarms. In addition to the use
of software that delivers text
alerts of the patient's alarms
to the nurse's business cellphone, paramedics confirm
the alarm signal quality is
acceptable and confirm the
patient's clinical appearance.

BEYOND ALARMS
In addition to addressing patient alarms in real-time, the
CLC performs automated
surveillance of the electronic health record (EHR) using
customizable messages to
alert the care team of a potential medical emergency.
For example, a clinical rule
was created for central
line-associated bloodstream
infections (CLABSI). Any
inpatient with a tunneled
or non-tunneled central
line, port or peripherally
inserted central line is assigned a score of "one" and
automatically placed on
the electronic watch list on
one of the CLC screens. If
the patient develops a fever
or an elevated white blood
cell count (WBC), he or she
is immediately assigned a
score of "two." If the patient
develops a fever and an
elevated WBC, a score of

"three" is assigned, and the
paramedic reviews the EHR
for the prescription of an
acceptable systemic antibiotic. If an antibiotic is not
prescribed to the patient,
the paramedic sends a text

The CLC monitors:

80
patients in
Orlando

120
patients in
Delaware

24
hours a day

to the attending physician
notifying him or her of the
risk factors present, and to
consider prescribing a broad
spectrum antibiotic. Other
clinical rules the system
tracks include neonatal sepsis and catheter-associated
urinary tract infections. As
part of CHA's Improving
Pediatric Sepsis Outcomes
Collaborative, the hospitals
use the septic shock tool
from the American Academy
of Pediatrics. The CLC paramedics trigger huddles with
clinical teams when the
shock score reaches a predetermined value.
Other functions of the

CLC include text reminders prior to the end of the
shift, which enables nurses
to complete documentation
compliance in near realtime. Paramedics also surveil the patient abduction
system, where the use of the
video camera is critical.

FUTURE USE
Hospital leadership estimates the financial cost
the CLC generates is at
least $6 per occupied bed
per inpatient day. This is
based on the frequency of
alarms, number of patients,
time required to answer
and determine false vs. true
alarms, number of minutes
to coordinate an appropriate clinical response and a
nurse's hourly salary. In the
future, the system could be
used for real-time tracking
of patients with chronic
conditions in their homes or
community hospitals, or the
coordination and facilitation of a patient's journey on
a clinical pathway. To maximize the potential safety
nets cast by using technology like the CLC only
requires a combination of
imagination and innovation.
Adalberto Torres Jr., M.D.,
M.S., is the chief of Critical
Care, medical director of the
Clinical Logistics Center;
and Daniela Melendez, RN,
is nurse manager at the
Clinical Operations Center at
Nemours Children's Hospital,
in Orlando, Florida.
Tell your hospital's story. Email
magazine@childrenshospitals.org.

CHILDREN'S HOSPITAL S TODAY Winter 2018

13



Table of Contents for the Digital Edition of Children's Hospitals Today - Winter 2018

Contents
Children's Hospitals Today - Winter 2018 - Intro
Children's Hospitals Today - Winter 2018 - Cover1
Children's Hospitals Today - Winter 2018 - Cover2
Children's Hospitals Today - Winter 2018 - Contents
Children's Hospitals Today - Winter 2018 - 2
Children's Hospitals Today - Winter 2018 - 3
Children's Hospitals Today - Winter 2018 - 4
Children's Hospitals Today - Winter 2018 - 5
Children's Hospitals Today - Winter 2018 - 6
Children's Hospitals Today - Winter 2018 - 7
Children's Hospitals Today - Winter 2018 - 8
Children's Hospitals Today - Winter 2018 - 9
Children's Hospitals Today - Winter 2018 - 10
Children's Hospitals Today - Winter 2018 - 11
Children's Hospitals Today - Winter 2018 - 12
Children's Hospitals Today - Winter 2018 - 13
Children's Hospitals Today - Winter 2018 - 14
Children's Hospitals Today - Winter 2018 - 15
Children's Hospitals Today - Winter 2018 - 16
Children's Hospitals Today - Winter 2018 - 17
Children's Hospitals Today - Winter 2018 - 18
Children's Hospitals Today - Winter 2018 - 19
Children's Hospitals Today - Winter 2018 - 20
Children's Hospitals Today - Winter 2018 - 21
Children's Hospitals Today - Winter 2018 - 22
Children's Hospitals Today - Winter 2018 - 23
Children's Hospitals Today - Winter 2018 - 24
Children's Hospitals Today - Winter 2018 - 25
Children's Hospitals Today - Winter 2018 - 26
Children's Hospitals Today - Winter 2018 - 27
Children's Hospitals Today - Winter 2018 - 28
Children's Hospitals Today - Winter 2018 - 29
Children's Hospitals Today - Winter 2018 - 30
Children's Hospitals Today - Winter 2018 - 31
Children's Hospitals Today - Winter 2018 - 32
Children's Hospitals Today - Winter 2018 - Cover3
Children's Hospitals Today - Winter 2018 - Cover4
https://www.nxtbook.com/nxtbooks/cha/cht_winter_2024
https://www.nxtbook.com/nxtbooks/cha/cht_fall_2023
https://www.nxtbook.com/nxtbooks/cha/cht_summer_2023
https://www.nxtbook.com/nxtbooks/cha/cht_spring_2023
https://www.nxtbook.com/nxtbooks/cha/cht_winter_2023
https://www.nxtbook.com/nxtbooks/cha/cht_fall_2022
https://www.nxtbook.com/nxtbooks/cha/cht_summer_2022
https://www.nxtbook.com/nxtbooks/cha/cht_spring_2022
https://www.nxtbook.com/nxtbooks/cha/cht_winter_2022
https://www.nxtbook.com/nxtbooks/cha/cht_fall_2021
https://www.nxtbook.com/nxtbooks/cha/cht_2018spring
https://www.nxtbook.com/nxtbooks/cha/cht_2018winter
https://www.nxtbook.com/nxtbooks/cha/cht_2017fall
https://www.nxtbook.com/nxtbooks/cha/cht_2017summer
https://www.nxtbook.com/nxtbooks/cha/cht_2017spring
https://www.nxtbook.com/nxtbooks/cha/cht_2017winter
https://www.nxtbook.com/nxtbooks/cha/cht_2016fall
https://www.nxtbook.com/nxtbooks/cha/cht_2016summer
https://www.nxtbook.com/nxtbooks/cha/cht_2016spring
https://www.nxtbook.com/nxtbooks/cha/cht_2016winter
https://www.nxtbook.com/nxtbooks/cha/cht_2015fall
https://www.nxtbook.com/nxtbooks/cha/cht_2015summer
https://www.nxtbook.com/nxtbooks/cha/cht_2015spring
https://www.nxtbook.com/nxtbooks/cha/cht_2015winter
https://www.nxtbook.com/nxtbooks/cha/cht_2014fall
https://www.nxtbook.com/nxtbooks/cha/cht_2014summer
https://www.nxtbook.com/nxtbooks/cha/cht_2014spring
https://www.nxtbook.com/nxtbooks/cha/cht_2014winter
https://www.nxtbookmedia.com