This Illinois area initiative to use high-tech to speed up the identificaion of potential organ donors is a wonderful example of what can be done to help save the lives of people waiting for organs.
By Barbara Kois
Hoping to improve patient monitoring, three healthcare systems in the Chicago area — Provena, Advocate, and Resurrection — are implementing the eICU program. As an added benefit, the program also increases identification of potential organ donors.
"We better monitor patients, sending their vital signs into the central location 24/7 by streaming the data over satellite in real time," says Becky Rufo, RN, CCRN, DNSc, eICU operations director at Resurrection Health Care. "By monitoring vital signs coming in continuously, the central location is essentially doing virtual rounds on patients and providing nursing assessments. Then we can capture indicators that could lead to additional viable donors."
Every patient room has a video camera, microphone, and server that allow offsite healthcare professionals immediate access to vital signs from bedsides and labs. In addition, the technology also helps intensive-care physicians and critical-care nurses identify organ donors.
Bedside nurses overloaded with the daily demands of patient care might not be able to identify a potential donor in time to make a difference. The eICU program identifies potential donors earlier, making it more likely that it's not too late to use the donated organs to save lives.
In addition to increased organ donor referrals, Rufo has seen many benefits from using the eICU program, such as preventing complications and errors. The program also allows for two-way communication between the patient's room and the eICU center through videoconferencing.
However, one issue is identifying potential donors early enough to ensure organ viability.
Rufo says her facility worked with the Gift of Hope in Elmhurst, Ill., to create a protocol template to guide the process and develop nurse training materials. The new process identified 14 organ donor referrals in the first five months of its use. Two of those referrals went on to become organ donors, which is better than the average 10 referrals that produce one donor.
The system, created by VISICU Inc., uses advanced technology to connect ICU patients and their bedside care teams with remote centralized eICU centers.
Rufo is implementing the eICU program and also leading the organ donation program at Resurrection Health Care with the help of her staff and ICU managers.
"It's a powerful system that has reduced mortality and length of stay in the first six months of the program. We have experienced clinical, operational, and financial improvements through using eICU," says Rufo. "We also have had two multi-organ donors who have assisted six or seven patient recipients with their donations, along with frequent referrals of possible candidates."
Dean Lichtenfeld is director of clinical training and staff development at Gift of Hope, a federally designated organ and tissue donor network serving most of Illinois and northwest Indiana. The organization identified referral criteria to meet federal regulations for organ procurement and works with Advocate, Provena, and Resurrection to meet the criteria and use the eICU program to find potential organ donors.
"Provena was the first to adopt our referral criteria, providing an opportunity for the eICU to be involved once they saw clinical triggers for organ donor referrals," says Lichtenfeld. "The eICU is flagged when a person monitored via electronic surveillance exhibits one of the triggers that include being on a ventilator, having a traumatic head injury, and having a DNR order in place."
The eICU contacts the nursing unit caring for the individual and gives the bedside nurse the option of calling Gift of Hope or having the eICU make the referral. Referrals made by the eICU are documented and communicated to bedside staff and from shift to shift electronically.
In response to a referral call, Gift of Hope sends staff to evaluate and determine whether the patient is eligible for organ donation. If it is determined a potential donor is eligible, Gift of Hope collaborates with hospital staff to approach the family. The eICU also can assist with donor maintenance when physician intervention is needed.
"We partner with Gift of Hope, and they come in twice a week and do rounds in the ICUs in our eight hospitals through the eICU program, reviewing patients who meet certain clinical criteria," says Cindy Welsh, RN, MBA, who administers the eICU program at Advocate Health Care. "When they identify a patient who could become an eligible candidate, they then talk to the bedside clinicians."
Because of the demands of patient care at the ICU bedside, it can be hard for nurses to screen and identify possible donors and call Gift of Hope.
"Using our electronic monitoring system, Gift of Hope can review 268 patients in one location instead of having to travel to 15 ICUs in eight hospitals," says Welsh. "They are able to monitor patients in a more timely way, and they have found several potential donors who had not been previously identified at the bedside."
Welsh also says the enhanced organ donor identification system does not decrease patient care. "Just because you alert the Gift of Hope coordinator doesn't mean you're giving up on the patient," says Welsh. "Instead, it's a process of looking at the patient early to try to save even more lives."
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