When the Ebola outbreak hit the news last summer, the experts at ECRI Institute, a Pennsylvania-based patient safety organization and recently re-designated Evidence Based Practice Center, were already thinking about how to protect patients from infection. They sat down last summer to start thinking about the Top 10 C-Suite Watch List. Among the items they were looking at was disinfection robots to help prevent hospital-acquired infections. The item ended up number one on the list, says Robert Maliff, director of the applied solutions group at the institute. While it likely would have made the list, he says the Ebola outbreak probably pushed it to the top. “There was a huge spike in interest,” he says.
There are multiple kinds of robots — ultraviolet light and hydrogen peroxide vaporization, but they are expensive — $30,000 to $125,000 per unit — and ECRI recommends doing a trial before committing to purchase, and using them in the most important places to prevent infection, such as the ICU. Staff also need to remember that they do not mean regular infection prevention techniques and cleaning can slacken. “They do not replace infection control, but are in addition to excellent practices already in place,” Maliff says.
Second on the list was 3-D printing. Eventually, perhaps hospitals will print body parts, but for now, there is uncertainty about FDA regulation, he says. Now, they can be used for surgical planning and for simulations of complex surgeries. “It is not something that every hospital will have, but the price will fall over the years. For now, it may be better to take a regional approach to this.”
Middleware came in at number three. Traditionally thought of as personal devices in healthcare (PDAs, tablets), it is actually any piece of software that facilitates communication between other programs. ECRI thinks that middleware may be a way to help with the issue of alarm management by gathering information on alarms, prioritizing them, and determining when to escalate. Costs can be more than $100,000 to create a middleware system for alarm management.
Do you need a post-discharge clinic? It is a topic that’s on a lot of hospital radars, and ECRI spotted the trend and put it fourth on its list. The idea is that by having a clinic in the hospital, you can capture some of the potential bounce-back patients before they end up in the ED as an unplanned readmission. Patients can’t always get to their own physician in a timely manner, or they do not have one. With readmission penalties increasing this year, the idea is not far-fetched, and the report gives some examples of hospitals that have made it work.
Google Glass, at least in a hospital setting, might have some uses, Maliff says, explaining the fifth item on the list. In training, education, and proctoring, there could be benefits. Hospitals may want to wait to see what apps are developed before investing. In time, there may be ways that the specs can be used instead of monitors.
Hospitals that have bariatric surgery offerings might consider some of the new anti-obesity devices that are available, the sixth item. Some are closer to FDA approval than others. Regardless, though, Maliff notes that unless insurers opt to cover them, they won’t take off.
At number seven: Do adolescents and young adults need a special cancer center? If you are a children’s hospital, should you consider it? If you are a general hospital should you? We know that the human body doesn’t fully mature until it is 25, which is a good argument from a quality perspective for keeping adolescent and young adult care with the kids. But even older younger people — those who are up to about 30 — seem to want a different style of care than their older counterparts, says Maliff, and given the emphasis put on patient satisfaction, it might be a good idea to consider those needs. “They want different amenities, like Wi-Fi everywhere, and some treatment protocols may be different for this age group,” he says. But cancer is largely a disease of the aged, so unless you live in a large metropolitan area, Maliff says chances are your hospital may find it difficult to find a big enough population to create such a specialty center.
The eighth place on the list went to a surprise and slightly gross entrant: fecal transplants to treat C. difficile and other gut ailments. “The fecal microbiota transplantation surprised people,” Maliff says. “It has been around for a while but made the list because it is starting to expand to other disorders and is changing its mode of administration. There is a lot of research going on.”
The FDA is expected to issue some guidance on the topic this year. So far, payers are covering only for the C. diff treatment, not the treatments for ulcerative colitis, Crohn’s disease, and other disorders that are currently being researched.
The penultimate entry, artificial pancreas systems, is of great interest because of the epidemic of diabetes in the United States. This is largely a patient management issue.
Lastly, telehealth made the list. The experts gathered to come up with the list noted that the American Medical Association released a set of guiding principles related to telehealth in 2014, and organizations such as Microsoft and Google are involved. “Is there enough business interest and success stories out there that we have reached the tipping point?” he asked. “Every hospital better have an adoption strategy or you will be locked out. This is a way for you to manage patients, keep track of them, and keep them from unplanned returns. It is a big word that means a lot of things.”
A link to the report can be found on the ECRI website at http://www.ecri.org.
Next up, the organization will be releasing its Top 10 patient safety list this spring.
For more information on this topic, contact Robert Maliff, Director, Applied Solutions Group, ECRI Institute, Plymouth Meeting, PA. Telephone: (610) 825-6000.