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Mission: Critical

Imagine 30% fewer deaths in intensive-care units and half the medication errors in hospitals. IT is poised to deliver improved patient care.

It's a bit after 10 p.m., and a patient is in the intensive-care unit of Sutter General Hospital in Sacramento, Calif., following surgery to remove a section of dead bowel tissue. The patient's vital signs are deteriorating, which, given the surgery, probably means a section of dead tissue remains or, worse, the patient is septic, a potentially deadly blood and tissue infection.

Dr. Daniel Ikeda is about two miles away, trying to monitor the well-being of more than two dozen patients, including the one in trouble. Ikeda and a registered nurse sit at workstations, scanning several computer displays of information, including real-time vital signs in what's called the electronic intensive-care unit. An alert sounds, signaling that the patient's vital signs have changed. Ikeda checks what surgery has been done and can even look at the patient using a Webcam in the room. He calls a nurse on the floor to start intravenous fluids and a stronger antibiotic, and he tells an assistant to call a surgeon. Emergency surgery begins around midnight.

Sutter hospitals are among hundreds deploying bar-coded drug systems so nurses can scan drugs at patients' bedsides and receive alerts if they're giving the wrong medication.
The Sutter Health hospital network in Northern California is testing an electronic intensive-care unit that lets one doctor and one nurse remotely monitor dozens of patients at once. Without the system, the pressure would've been entirely on the nursing staff to spot the pattern of weakening vital signs and make the call that it's worth rousting a doctor and a surgeon about a possible midnight operation. Ikeda says the remote center removes him from the distractions and pressures of the intensive-care floor to scan all the patients at once for signs of trouble. "When I'm in the eICU, I'm a lifeguard," says Ikeda, director of Sutter Health's new online intensive-care system. "I use the technology to look for troubling trends," before they become serious complications. "A critically ill patient can turn sour in a matter of minutes."

IT is poised to change dramatically how patients are cared for, and in the process possibly save tens of thousands of lives a year. How? Sutter expects death rates in intensive care to drop a stunning 30% by 2006 when the electronic-monitoring system will be in place across all its hospitals, tracking more than 460 patients. That's right--three out of 10 patients who die today in intensive care would not. Stunning, but also realistic. Sentara Norfolk General Hospital in Virginia, the first hospital in the country to test the system, saw a 25% drop in mortality rates in the first six months of use compared with the previous 12 months, according to a report commissioned by Cap Gemini Ernst & Young.

So far, much of the IT spending in health care has been tied to transactions--creating electronic health records or improving payment efficiency. The next great leap will come from tools that save lives by improving patient safety, boosting quality of care, and reducing errors.

That's important. The National Academy of Science's Institute of Medicine estimated in 1999 that 44,000 to 98,000 people die from medical errors each year--greater than the number of people who die annually in automobile accidents.

Many efforts are just getting started. Visicu Inc., the company founded by two doctors from Johns Hopkins University to create the electronic ICU system Sutter Health and Sentara use, is working with several other hospital chains on similar projects.

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