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Remote Presence in Intensive Care: Impact on Leapfrog and IHI Guidelines

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Remote Presence in Intensive Care: Impact on Leapfrog and IHI Guidelines

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    1. Remote Presence in Intensive Care: Impact on Leapfrog and IHI Guidelines Paul M. Vespa, MD FCCM Director of Neurocritical Care Associate Professor of Neurosurgery and Neurology David Geffen School of Medicine at UCLA

    2. The problem We are becoming a Guidelines Nation Evidence based medicine is being used to form guidelines Compliance with guidelines is being tracked Compliance with guidelines is being marketed How do we meet the challenge of guideline compliance?

    4. Leapfrog ICU Physician Staffing

    5. Leapfrog Scoring and Marketing

    10. IHI ICU Care Measures

    11. Mistakes in the ICU are costly

    12. There is resistance to this concept

    13. UCLA Study of Bundles in the ICU

    14. ICU Bundle Compliance Data 2007

    15. How does the Robot Help? Get started on the right track – admission orders, discussion Keep on the right track – routine interactions, near misses, bundle compliance Rapid Response

    16. How can the robot help to improve quality of intensive care in the future? Automated data summary for ICU Bundles Rapid Response Emergency ICU Response Beyond the borders of the ICU

    17. Automatic ICU Bundle Compliance Template work list in print or electronic format Compliance check list for physician to see Information portal to provide education to staff

    18. Emergency Response Systems Errors occur during prehospital care, and there is a trend to try to monitor incidents for quality improvement. Introduction of a prehospital critical incident monitoring system--pilot project results. Prehosp Disaster Med. 2008 23:154-60. Resuscitation outcomes registries are being formed Resuscitation. 2008 Aug;78(2):170-178

    19. Emergency Response Factoids Transmission of a prehospital 12-lead ECG directly to the attending cardiologist's mobile telephone decreased door-to-PCI time by >1 hour patients were transported directly to PCI centers, bypassing local hospitals.

    20. HEMS

    21. Advanced Prehospital Care by an Intensivist may be better for outcomes

    22. Lack of qualified physicians in the prehospital care may be crucial OPALS study (CMAJ 2008) No improvement in outcome if paramedics perform ACLS in the field Low GCS is a key determinant factor Call for reassessment of how and when paramedics should deliver ACLS Davis (Current Op Crit Care 2008) Intubation for TBI is difficult, and hence some harm may offset potential for benefit Newton (J Trauma 2008) Intubations in the field by MD experts have low complications (HEMS)

    23. How to improve rapid response

    24. Being there to assist ICP monitor insertion

    25. Neurologic Monitoring

    26. The Future in Rapid Telepresence Response

    27. Advanced Care in the Field

    28. Bedside Non-invasive Neuro Diagnostic testing and Intervention

    29. TCD for acute stroke

    30. Rapid Response in the Field Thermal Imaging

    31. Thermal Imaging in Emergency Response

    32. This is not just science fiction Telepresence Integration into Neurologic monitoring - UCLA Military Use of RP7 BAMC, Landstuhl, Water Reed Pre-hospital smart phone technology Mobile Head-only unit of RP7

    33. The Future Routine use of Robot to keep on the guidelines Rapid Response facilitated by Robot Novel product development to turn Robot into a diagnostic and therapeutic instrument

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