Johns Hopkins intensive care nurse Nelly E. Lopez spends so much of her workday monitoring patient distress alarms that she sometimes hears phantom beeps even when she is no longer on the job.
Hopkins doctors say Lopez's "alarm fatigue" shows what is wrong with hospital intensive care units, which they describe as fragmented systems made up of dozens of machines that don't talk to one another. The constant alarms, invasive instruments and unwieldy number of machines create a stressful, and sometimes unsafe, environment for the medical staff as well as ICU patients, who are the ones in most critical condition.
Hopkins has a plan to bring ICUs into the 21st century and has joined forces with an unorthodox partner, defense contractor Lockheed Martin, to make it happen.
The hospital's Armstrong Institute for Patient Safety and Quality has entered into an agreement with Lockheed to combine the two institutions' expertise to create an updated, more efficient ICU. They hope an improved ICU will have widespread benefits: enhanced patient safety, reduced costs, fewer medical errors and a smoother work environment for hospital employees.
Ultimately, the medical institution wants its ICU model to be used around the world and as the groundwork for similar systems to be used in the operating room and other hospital departments.
"Hospitals do good, but they can be dangerous places," said Dr. Peter Pronovost, Johns Hopkins senior vice president for patient safety and quality and director of the Armstrong Institute. "We should be able to create an ICU that reduces risks to patients."
Hopkins will combine its clinical knowledge with Lockheed's engineering prowess to create a single system in which machines communicate with and complement each other. Hospital ICUs now contain 50 to 100 pieces of equipment made by dozens of different designers that aren't integrated.
Pronovost envisions an ICU that notifies a nurse when a pneumonia patient's bed falls below a 30-degree angle. Now nurses have to walk into a patient's room and constantly estimate the angle.
A centralized system would monitor various patient symptoms to help detect diseases like sepsis, which is hard to diagnose because there is no one test for it. Now, nurses and doctors would have to check patient symptoms from several machines to detect the disease.
Patients with acute lung problems, who need regular breaths from an oxygen machine, would get them automatically. Electronic medical records would "talk" to the breathing machine.
"It is really simple from an engineering standpoint, but it hasn't been done in a hospital setting," Pronovost said.
Hopkins and Lockheed are still working out details of the partnership, but analysts said it could turn into a future revenue generator for both institutions as the federal government looks to cut back defense and research spending to control the country's deficit. Lockheed could build the system and sell it to other hospitals, and Hopkins could collect royalties from helping develop it.
Lockheed is known for its defense business but has also built a decades-old health care business that includes providing information technology services to federal government agencies such as the Centers for Disease Control, the Centers for Medicaid & Medicare Services and the Department of Defense.
A Lockheed spokesman said the deal with Hopkins is a way to expand other parts of the business.
"Health care — both IT and in the clinical environment — is a strategic adjacent market for Lockheed Martin," said spokesman Christopher Williams. "As a global security company, we recognize rising health care costs as a threat to the nation's economic security."
Lockheed's expertise in building radars and other technologies for war zones could be easily translated to fit a medical setting, one analyst said.
"They can use the technology know-how they have to help make strides in the health sector," said Neal Dihora, an equity analyst with Morningstar.
Lockheed has created a system that simulates hospital settings used by medical institutions to train their staff virtually through the computer. Such simulation systems are used to train pilots in high-pressure environments by creating scenarios that could happen in the air.
Hopkins will use the simulation technology to test different approaches to the ICU. ICU workers would get job training the same way fighter pilots do.
Hopkins' Pronovost sees other parallels between the defense and health industries and often compares ICU systems to aerospace technology. He likes to point to past and present pictures of an airplane cockpit, which has evolved from many components to a more practical one-system model. The picture of an ICU has pretty much stayed the same over time.
"An airline doesn't build a plane by buying the different parts and then building it themselves," Pronovost said. "That is essentially what is happening in ICUs. We should be able to buy a hospital that works rather than cobbling one together."
One of the things that an improved ICU could do is reduce the number of alarms that nurses like Lopez deal with every day, Pronovost said. A single system could prioritize alarms based on the risk of a patient, looking at physiological factors, such as age, diagnosis and family history. A louder alarm would ring for more pressing needs. Nurses would be able to tell from a central location whether an alarm is ringing because of something like a misplaced valve or because it is truly an emergency.
"That would be great," Lopez said recently after hearing about the plan. "We spend all day running after alarms."
Hopkins is also working with Masimo Corp., a developer of noninvasive medical monitors, including a device that measures hemoglobin levels without having to draw blood. It instead uses acoustics to determine the levels by measuring the sound breath makes when traveling through the trachea.
Masimo chief medical officer Michael O'Reilly sees the problems of the ICU firsthand because he still practices medicine as an anesthesiologist in a hospital. He said the current system has the potential to put patients' lives in danger because there is too much room for human error.
During one recent surgery, a laser was being used to remove a tumor from a patient's airway. The patient also needed large amounts of oxygen administered during the procedure. But the oxygen machine and the laser couldn't operate at the same time without risking a fire. The doctors had to be in constant contact to make sure such a catastrophe didn't happen.
Masimo said better technology would make it impossible to turn on the laser unless the oxygen level was low. Or the oxygen would automatically shut down if the laser was used.
"We have a system that injures people one at a time slowly," O'Reilly said. "Data is scattered all over the place."
A coordinated system might prove to be a challenging sale to the dozens of manufacturers of medical devices who operate so independently now.
But because of Hopkins' reputation for top-notch standards, one health care expert said, people will pay attention.
"Their influence would be in the area of quality," said Joshua Nemzoff, a hospital consultant. "If Hopkins came up with an ICU that has better patient outcomes, they would certainly get the attention of a lot of people, based on their reputation."
Pronovost has created widespread medical change before. He led a national effort to curb blood infections associated with catheters by getting doctors to follow a basic checklist and changing the culture at hospitals. The system is now used in ICUs throughout the country.
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