A “save,” in hospital parlance, is a medical intervention that pulls a patient back from the brink. Hollywood has evoked a frantic emergency room with overtly heroic doctors and nurses as standard setting.

This does happen at UCHealth hospitals. But thanks to a combination of artificial intelligence and remote monitoring in close collaboration with onsite care teams, UCHealth is quietly making about 1,000 saves a year in much less dramatic fashion. Those saves are happening with patients who are already hospitalized and, for a variety of reasons, are deteriorating into life-threatening circumstances.

About five years ago, UCHealth launched a program to tackle sepsis-related deterioration – sepsis being the immune system’s overreaction to a systemic blood infection and the leading cause of death in hospitals.

“Sepsis is hard to detect, because it’s subtle until it’s not,” said Amy Hassell, chief nursing officer of the UCHealth Virtual Health Center. “It is high consequence, and it has time consequence – typically, for every hour that you get antibiotics, your mortality improves by 10%. You want to find it as early as you can.”

When the virtual pros first teamed up with nurses and doctors in hospitals to combat sepsis, they were soon making about 200 saves a year. The 5X boost in saves since then is in part due to rolling out the program systemwide during that time.

UCHealth’s latest additions, Parkview Medical Center and Parkview Pueblo West Hospital, have also begun virtual sepsis monitoring.  But the program has also improved with age, and some of the most impactful advances – including the most recent – have involved common-sense changes in how people caring for patients, whether onsite or virtually, interact.

“Virtual monitoring for sepsis is a game-changer for our patients,” said Maggie Welte, chief nursing officer at UCHealth Parkview in Pueblo. “By utilizing this advanced technology, we can detect sepsis earlier and respond more swiftly, saving lives and improving patient outcomes. This program reflects our dedication to delivering exceptional care.”

Virtual health, said Dr. James Caldwell, chief medical officer of UCHealth Parkview, is designed to support, not replace, bedside care.

“By implementing these high-reliability processes, coupled with advanced technology, we’re ensuring safer hospital stays for our patients,” Caldwell said.

Leading-edge monitoring technologies improve detection of sepsis-related deterioration

Technology has played a central role throughout. The Virtual Health Center’s deterioration monitoring system involves four embedded predictive tools – the Shock Index, the Epic Deterioration Index, the Epic Sepsis Prediction Model, and the Respiratory Distress Index – augmented by algorithms developed in-house by UCHealth data scientists and machine learning experts. The team modified the Epic electronic health record to enable the efficient screening of patients across a dozen UCHealth hospitals. Those tools are fed by a stream of data including oxygen levels, heart rate, blood pressure, body temperature, respiratory rate, lab results, medications being administered, and other factors.

About 1,000 cameras let the Virtual Health Center team observe patients at risk of deterioration or for whom the care team has already intervened. Some of those cameras are dispatched by one of about 150 patient technology technicians across UCHealth hospitals; some built into the ceilings of newer hospital rooms. The care team lets the patient and/or family know the camera is on, and it stays on for six hours unless the patient is transferred to a different level of care.

“The patients for the most part love this, and families love it, too, because they feel like they’re getting extra attention,” Hassell said.

One key to the success of the Virtual Health Center collaboration on deterioration is its long attention span, says Dr. Diana Breyer, UCHealth’s Northern Colorado chief medical officer. Take the example of an at-risk patient whose low blood pressure has been spotted and treated with additional fluids.

“They may give them fluid, but not check their blood pressure again for four hours,” Breyer says. “So, we’ve had a patient who has potentially been deteriorating the entire time. With this process, we’re going to check blood pressures frequently to make sure the patient is truly out of the woods. It’s about getting a consistent resource around the patient.”

A small adjustment brings surprising benefits in stopping sepsis and other deterioration

Those resources continue to be refined, Hassell says. The most recent advance was what seems like simple one. If the Virtual Health Center team notes repeated notifications of possible warning signs such as a low oxygen level or a too-low or too-high heart rate within 60 minutes, the Virtual Health Center team can directly contact the hospital’s onsite UCHealth rapid-response team. That avoids spending the time to catch up to and then discuss the patient’s status with the day-to-day care team on the hospital unit.

That may sound like a trivial adjustment, but it’s having a real impact. In the months following the process change’s implementation about a year ago, rapid-response team dispatches have gone up by 25%, Hassell says, and they’re seeing 8% fewer transfers to higher levels of care – say, from a floor unit to an intensive care unit. In UCHealth’s hospitals in Northern Colorado alone, they’ve seen rapid-response team dispatches double while a key index of patient mortality has fallen 26%.

The Virtual Health Center’s role isn’t to take over for bedside care, but to augment it, Breyer says.

“Putting these high-reliability processes in place, with the addition of technology, means safer hospital stays for patients,” she said.