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Logistics center helps to monitor patient vitals

At first glance, you might mistake it for an air traffic control center.

The Clinical Logistics Center at Nemours Children's Health System houses a wall full of monitors that display steady streams of data.

Staff scan the screens for anything out of the ordinary and make calls to flag problems.

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STRATEGIES:

Create a designed place where paramedics can monitor the vital signs of patients.

Allow paramedics phone and texting access to nursing staff so they can immediately reach them in emergencies.

Install speakers or cameras in patient rooms so paramedics can communicate with patients and families easily.

The center, at Nemours Children's Hospital in Orlando, Fla., is where paramedics are on duty 24/7 tracking the vital signs of all inpatients of the system, even those nearly a thousand miles away at Nemours duPont Hospital for Children in Wilmington, Del.

“What we are trying to do is as quickly as possible give the right information to the caregiver—acting as a second set of eyes to try to make nurses' lives easier,” said Dr. Stephen Lawless, chief clinical officer at Nemours, who led the development of the Clinical Logistics Center five years ago.

The center is connected to the heart rate monitors of every patient as well as their electronic health record. The information on the screens is labeled green, yellow or red—visual cues to the paramedic if something is amiss. Red indicates clinical support is immediately needed, green means the patient is stable. If paramedics see anything of concern, they text and call the nurses on the floor to alert them.

On an average day, five to six paramedics oversee the condition of up to 220 patients. The paramedics—employed directly by Nemours—work in the center on four-hour shifts to avoid burnout and maintain strong reflexes.

Lawless believes paramedics, who are trained to have a clinical sense of emergencies and love data and protocols, are the perfect healthcare professionals to be in charge of the center.

“From a temperament standpoint they are action-oriented,” he added.

The logistics center's monitors display when patients call for nurses. If after 30 seconds the alarm isn't answered, the paramedics shoot a text to the on-call nurse manager that a patient needs help. If the nurse doesn't answer the call after 90 seconds, the paramedics dial into the room through the speaker system and interact with the patient and family.

The paramedics follow a script where they ask if they can turn the camera on to view the situation in the patient's room. Every room has a camera. Only one patient is placed in every room, so privacy is never violated.

Paramedics can also dial into rooms if they see a patient's vital signs are fluctuating and the nurses haven't yet responded to calls or texts from them.

At first, clinical staff expressed concern that the camera and speaker technology was a bit like “Big Brother is watching you,” Lawless said. But the staff got on board after they recognized how an extra set of eyes and ears can improve care and help patients.

Nemours hasn't had a surprise code blue since the Clinical Logistics Center opened five years ago. “We are really being good about being pre-emptive,” Lawless said.

The center also has a live feed of wait times in the emergency departments. If the paramedics see the ED is overcrowded, they call nurse supervisors and suggest additional staff support.

The monitors recently began displaying each patient's sepsis score, which is calculated based on vitals for signs like a drastic drop in blood pressure. If a patient is believed to be in septic shock, paramedics immediately call the sepsis team to assess patients and administer antibiotics. With sepsis, time is critical.

“Now within minutes we can evaluate the patient,” Lawless said.

The staff now embraces the logistics center and even asks paramedics to watch patients who are particularly unstable. Nemours is currently working with its affiliated community hospitals to extend its command center services. “They don't have all the resources, but now you can have someone monitoring from far away,” Lawless said.

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