How Environment and Technology Can Improve Health Care

Putting comfort of patients first yields surprising results.

Jose B. Perez is attached to a constant monitoring system at Rush University Medical Center in Chicago.

Jose B. Perez is attached to a constant monitoring system at Rush University Medical Center in Chicago.

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[Advances in Health Care Bring Remote Expertise Close]

More than 800 robots now rove the halls of U.S. hospitals, increasing doctors' efficiency by letting them be in two places at once. And these stand-ins for people are taking on other duties, too. At the UCSF Medical Center, a robot packages 13,000 doses of medication, including IV solutions, every day, "virtually eliminating the opportunity for human error," says Michael Blum, a cardiologist and chief medical information officer at the center. Each dose gets a bar code that a nurse must match to a patient's wrist band before the medication is administered.

The number of robot-assisted surgeries – for everything from gall bladder removal to hysterectomy – has soared, though critics say there's still little evidence that the method produces better results than comparable minimally invasive procedures. (The FDA has been looking into robotic surgery in response to growing reports of problems, such as the arms moving improperly.) Other robots emit beams of ultraviolet light to kill potentially deadly bugs. A recent MD Anderson Cancer Center study found that a unit from a company called Xenex killed 95 percent of C. difficile bacteria – six times more than bleach, the standard disinfectant.

Change is also coming to the ICU, which faces a daunting challenge. In any given hospital, as many as 15 medical devices, including monitors, ventilators and infusion pumps, are connected to an ICU patient, but because they are made by different companies, they don't "talk" with one another. Patient-controlled analgesic pumps that deliver powerful narcotics, where a known side effect is respiratory depression, aren't linked to devices that monitor breathing, for example. "Today's ICU is arguably more dangerous than ever," says Peter Pronovost, senior vice president for patient safety and quality at the Johns Hopkins Medical Center in Baltimore.

[The Personalization of Medicine]

To address the need for "interoperability," health care and industry executives convened the first Patient Safety, Science and Technology Summit in January, and nine of the largest medical device companies pledged to share data and standardize device interfaces. According to a new report from West Health Institute, a research organization focused on reducing health care costs, true interoperability could save $30 billion by avoiding mistakes.

Meanwhile, design plays a role in intensive care, too. At Memorial Sloan-Kettering Cancer Center's 20-bed unit in New York, sliding glass doors are glazed with LCD privacy glass, which transitions from clear to opaque at the touch of a button and can be cleaned far more effectively than curtains. Monitors, medication pumps, oxygen, suction and power outlets reside in ceiling mounted mobile columns rather than in headboards, and no cables snake across the floor. "That allows us latitude and freedom that we would never have in standard rooms," says Neil Halpern, chief of the hospital's critical care medicine service. Seattle Children's similarly puts access to power and gases into movable booms so the medical team can quickly and easily get to the patient.

Wachter is cautiously optimistic that all this innovation will lead to better, safer care. But the smartest of technologies still leave no room for complacency. "We've learned how amazingly complicated it is," he says, "to reliably deliver care to sick people."


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