CE spotlight: Health system lowers VAP rates with eICU

Nurse Leader Insider, May 18, 2009

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Ventilator-associated pneumonia (VAP) is a constant headache for hospitals around the country. It has been on the list of the Institute for Healthcare Improvement’s interventions since the inception of the 100,000 Lives Campaign in 2005. It is one of the most acquired conditions by ICU patients on ventilators, and its presence exacerbates existing conditions and adds costly days to ICU stays.

To help lower its VAP rates, UPenn Health System in Philadelphia (UPHS) used an electronic ICU (eICU), a system already in place at the organization that used telemedicine to monitor patients, and realized a cost savings of more than $138,000 in a two-year span.

An eICU can add an extra level of monitoring for ICU patients because not only does it provide visual surveillance, but it also offers a level of data and analysis that bedside caregivers alone cannot provide.

“Telemedicine receives alerts and alarms through a software package,” says Joseph DiMartino, BSN, RN, outcomes coordinator at the Penn E-lert eICU, a part of UPHS. The eICU monitors quality initiatives at the Hospital of the University of Pennsylvania, Presbyterian Hospital and Pennsylvania Hospital. “That allows us to see and detect alerts for patients earlier than maybe the bedside nurse might see,” DiMartino says.

He explains that bedside caregivers often set patient alarms so they only go off in an emergency and are not ringing all day and becoming a distraction. The eICU’s system is set to be alerted whenever there is a 20% or higher change in a vital sign, and the eICU staff can alert the bedside caregiver if necessary. “They’ll set their range for heart rates, for example,” says DiMartino. “They may set their range for heart rates to be between 60 and 120. If the patient’s heart rate is anywhere between those two numbers, the bedside alarm is not going off. But if their heart rate is 60 and all of the sudden it shoots up to 119, we want to know that.”

Editor's note: This excerpt was adapted from the new CE article, “Health system lowers VAP rates with eICU” featured in The Reading Room on HCPro's online resource center,

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