In this incredible webinar, Charles Jones from AMI, shares his first-hand accounts of how he witnessed the ViSi Mobile system save lives at the Georgia World Congress Center's COVID-19 Alternative Care Facility.
Transcript
Speaker 1: Matt Bacino, Sotera Wireless
I would like to introduce Charles Jones, clinical lead from AMI.
Speaker 2: Charles Jones, AMI
Well, good afternoon, everybody. From a very beautiful day in Atlanta, it's actually my next to the last day here, I will be leaving tomorrow after we've concluded what I consider to be a very successful mission here. In fact, we believe it's probably gonna prove to be the single highest-rated deployment of an alternate care site that's completely removed from the hospital. We were in the Georgia World Congress Center, which is basically a conference center here in Atlanta, and we've been here for three different iterations. So we started back in April-May of 2020. We came back through July, August and September, and then we came back again this year, January-February. And we, closed our last patient out on February 28th and have kind of been in the demo process. I actually started with AMI (an expeditionary health organization) started with them in April of 2020 here at Atlanta to help get this site up and running. I'm, paramedic have been since 1992. I'm, an instructor for EMT also carry ratings as a critical care paramedic, flight paramedic and a tactical paramedic. I'll say all that because I came up in a medical family and was taught very well by intensive care nurse who was my mother and who instilled in me the importance of treating all of our patients as though they're family members. So anytime I'm involved in a situation like this, I try to carry that adage through and and promoted with my staff as well. I've also worked in a lot of hospitals, done quite a bit of hospital work both in the emergency room and critical care units have also worked as part of a vascular access team within a hospital. So I'm familiar with the needs of hospitals as they relate to issues like this. And frankly, I'm pretty honored to be a part of this webinar with the relationship that we've had with the ViSi product and how it's worked here. So I'm very proud of our mission that we've done and very happy to talk about it.
So let me start just a little bit and tell you about Atlanta, the one that was our first iteration here back in April. I actually came here to be a respiratory therapist, but very quickly I was appointed as the chief safety officer here, and I was responsible for everything related to safety not only with the patients but also obviously with the staff, and that's as it relates to PPE site safety. If the floors were kept clean, you name it, and my first responsibility and to this day is to take care of my staff. If I don't have staff that's healthy and able to do their jobs and able to do their jobs well, then I can't take care of patients. So I have to look out for them first. And that was really instilled in me quite well with with the first version that we did here. We were fortunate with that one that we had a relatively low number of patients. I think we had a total of 17, never more than 10 at any one time, and that's actually very good for us, and it taught us a lot of lessons. One of those was the fact that we did not have any type of a monitoring solution, so literally every blood pressure that was taken was done with a manual cuff or a dynamo app. The unfortunate reality of that when we're dealing with the pandemic is that equipment had to be moved from patient to patient to patient and it was generally one or two people who were moving that from patient to patient patient, increasing chances of some spread and some other issues. So when we closed out, the one we sort of left the laundry was just some things that if we came back, would be important to us.
And I was brought back for version two as one of the team leads. So I had overall responsibility at this point for the entire site. From a clinical standpoint, one of the first things they told us I got here about two weeks before the first patient as part of the advance team. One of the first things they told us is that we would be receiving quite a few more patients for that time and that the patients would be sicker and in fact it turned out to be very accurate. We had, I think, on that one round 109 patients, if I remember correctly, all total and a lot of those patients came to us directly from the ER, having just been diagnosed positive, we also got a tremendous number directly from intensive care after they just come off of the vent. We also had a situation on that one where we had several nursing home patients that had a particular facility here that experienced an outbreak. And we ended up with quite a few of those patients. So that gave us a wide varied group of patients that we were dealing with, including everything from total care to walkers. We had all different levels of acuity up through a high mid acuity. We don't have capabilities here, so we obviously stopped there. Well, so didn't have plumbed oxygen. So we had some challenges that were facing us. And one of the important things was that we needed to be able to recognize a patient that was deteriorating as quickly as possible. That meant we had to have some sort of a monitoring solution and a monitoring solution that that was basically real time.
The idea of the concept of going room to room with manual vital signs just really was going to be fraught with all sorts of problems. So we set out very quickly to identify a solution the first two or three that we encountered. Um, single biggest problem with those is we were looking at a minimum, a six week delivery time, and that simply didn't work for us. We had one week to get a solution on the ground. So our partners here on the healthcare side was Grady health systems, and Grady had actually utilized the ViSi solution in their hospital and mentioned to us that we might want to check into it. So we reached out very quick response. Amazingly fast turnaround time on on getting information back, including quotes and everything else, I talked with Grady and the success that they had had with it, and basically a long short of it is we ended up deciding to go with that solution. What happened next was, frankly, pretty amazing.
We had the first monitors on site within three days, and one of the beauties of that solution was it fit directly in with the existing WiFi infrastructure that was already there, present in the facility, significantly reduced our cost. But mainly it significantly accelerated our deployment time because that infrastructure was already there. It was something that we could run off of, so that was actually very, very crucial to us. The shipping all happened very quickly. Grady also had already worked out in integration with their EMR. So that meant all of our vital signs were able to flow directly into patient charts. Nurses got the opportunity to go in and validate that those vital signs were correct. That obviously cut down significantly on our staff, uh, the need to directly physically interact with our patients. Obviously, the importance of seeing a face and talking with someone was still maintained that every time we touch the patient, we increase the possibility of something bad happening. So this enabled us to maintain our patient interaction without having to have that direct physical contact. And I say that because this solution is a complete monitoring solution once it's placed on the patient, there's two times that we touch that patient every day. And that's when we're changing out the packs because of battery. Other than that, and I'll certainly let Dulayne speak much more intelligently than I about the technology. But once we have that calibration done, once that pack has changed out, we get continuous vital sign monitoring on this patient, including blood pressure. Um, and to be perfectly honest, it's probably the closest thing I've personally seen short of an arterial blood gas or I'm sorry an arterial line in giving us a real time, continuous blood pressure monitoring solution. Uh, frankly, it saved some lives. We were able to spot some things early on, so we have blood pressure, pulse, respiration, temperature, even movement. And I'll talk more about that in just a moment because that actually turned out to be pretty crucial. Um, once we got the devices here, the next step was training our staff. Now, although we had a total of around 1100 staff members from point A to point Z one at one time, we had around 172 staff members that we had to train. And the training was all inclusive. It included not only their orientation to the site, their use of the PPE that was specific to the site, and epic. The electronic medical record we were using. But the IV pumps, oxygen delivery devices, communications are treatment protocols. All of that had to be trained over a period of two days. And in addition to that, we had to train them on the ViSi system. So one of the ways that ViSi was able to help us is they provided us with some e-learning tools. So literally as soon as our staff would sign a contract before they would even get on the plane, we were able to deploy these e-learning tools to them. So by the time they got here, they already had a basic understanding of how this system was going to work. So it worked out really, really well. Uh, ViSi was here on site to do training with us, and we also trained some super users in that. So all that work, the training worked out remarkably, remarkably well.
The next step was setting up our monitoring suite. Now, when I say a monitoring suite, I don't want you to think about what you may have in a hospital now or what you may have experienced as like a cardiac telemetry type suite. That's not really what I'm talking about, although it may look the same. You walk in and you've got desks and tables with multiple monitors on them with wave forms being displayed. But normally all you're seeing there is a simple, really EKG. That's not the case here. We've got complete monitoring of everything. So one of the unique things that we did is placed in certified paramedics watching those monitors. We did that because there is a significant nationwide push right now to recognize septic issues, to recognize all sorts of things and especially as it relates to covid. So by placing paramedics there who could not just see what was going on the screen but could interpret to some level, they were able to spot things well in advance, which helped us get patients out to a higher level of care when necessary due to deterioration. The other thing, by recognizing something very early on in the process, there were several times that we were able to do something here to prevent further deterioration, whether that might have been antibiotics or something as simple as prone in a patient for a period of time to help relieve those issues. So it reduced our overall requirement to transfer patients out to other facilities. But at the end of the day, I will tell you, I believe that saved some lives and I'll give you some statistics at the end here in a few moments to kind of back that up.
Um, so the monitoring was really incredible. And I think the Dulayne may have a particular story there that I'll let him tell. I don't want to steal his thunder on that, Um, some other benefits that we immediately realized once we got the solution in working and had it placed on patients, we had a particular patient that fell. And one of the unique things about the ViSi system is through some of the technology. They can actually make an alert when a fall happens. This patient was found to be in the floor, and the unique part about that is it was at night when rounding was only about every 2 to 3 hours. That patient literally could have laid in the floor for two or three hours before we found him. They weren't yelling out for help or anything else, but the fall alert went off. They notified the focus on the floor to go check on this patient, and they did find them, in fact, in the floor. Had we not found them that quickly? Who knows what other issues may have developed from pressure ulcers and everything else is being on the floor for that long. We found that to be true. Fortunately, we only had a total of about three or four falls. But in all cases, with the exception of one when the patient did not have a ViSi monitor on all of the others, we were alerted to that by the ViSi system. So that was pretty crucial.
You might also remember I mentioned that we had several nursing home patients and several of those were total care. Another thing we were able to do with the ViSi system was set up alerts on our patients who are either at risk for or already suffering from bedsores, and by placing these alerts on their we would we could tell if a patient had not moved within a couple of hours. That way we were able to notify the staff on the floor. We need to go roll the patient to help speed up that recovery or prevent the bedsore from happening in the first place. So that ended up being a very, very important to us. One of the things that we benefited significantly from was we got away from having to have sitters with a bunch of our patients. I mentioned again all the nursing home patients, but we had some others that were considered elopement risks and the fact that we did not have to put a sitter on those patients not only helped reduce our staffing requirements, save staffing money in dollars. But it also prevented me having to put people in the hot zone for the sole purpose of sitting in a chair and watching a patient in case they got up. That's because one of the things ViSi was able to do for us is notify us when a patient gets up and begins to emulate. So that dramatically reduced the number of people we had to have in the hot zone procure monitoring. So that was a huge, huge win for us. We came back for Atlanta V three to January 1st was when we brought our first patient. And then, um, we were told then to expect double the number of patients that we've had for the second time that panned out. We had 217 patients that came through our facility. Um, during that time we had taken all the lessons that we learned, especially in V two, and we kind of streamlined a few things with ViSi. And part of that was an escalation pathway.
So I mentioned that we had paramedics that were actually in the monitoring suite watching everything. If they would notice a problem, they would immediately notify one of our busy super users on the floor. There's a super user would go check on the patient because many times it was a lead that had slipped off, maybe need to be replaced something along those lines, and they would be able to fix it immediately. But those folks were also all ENTs, and if they did notice a problem, they would escalate to a respiratory therapist. A lot of times would have protocols in place that could handle things with and if they couldn't then would escalate to a provider. So we really significantly reduced our false alarms, Um, and really kind of tweaked and fine tuned the system into such a way that something very unique happened. And one of the things was that one of our physicians that was here, uh, felt like these patients not all patients needed ViSi because they didn't need cardiac monitoring and it took a while before that made it up to our level that we realized that that admonition had been placed down. And the reason that's important is because they actually said take these monitors off some of these patients that lasted for about 24 hours because the way I heard about it was when nursing came to me and said, we don't know what's going on, but we don't like it. We need our ViSi back. And those nurses basically demanded that we get the ViSi monitors back on the patients and it didn't have anything to do with laziness or anything else. They liked the fact that they were finding out what was going on with their patients as quickly as possible, and and they had lost some of that capability. Um, and then in the process, we were able to educate the doctors to the fact that this is not just cardiac monitoring. This is monitoring everything and giving us huge insights into the patients and what's going on with them. So again, another big win there that one proved out to be, Uh, certainly the third iteration turned out to be our most successful deployment and use of ViSi.
No one complained about it. It was amazing how well it pulled off. So from the Atlanta side, I'm happy to take and answer any questions anyone may have about it. But let me give you a couple of takeaways, and I'm gonna give you some stats. So all total across all three iterations, we had 131 clinical days that we had patients on the floor. During all three. We had a total of 332 patients that we treated and saved the hospitals around this area. 2600 bed days. So tremendous burden relieved off of some of the infrastructure here in Atlanta, probably. There's two statistics, though, that I am by far the most proud of one of those is that we had zero patient deaths, not a single one. And I include that, not only did no one die at our facility here, but including the ones that we recognized deterioration and were able to get them to a higher level of care. Now, many of them went on the vent as soon as they got to Grady, but we had none that died and I attribute a large part of that to the fact that we were able to spot issues with these patients as quickly as we as we could 100% due to the ViSi solution. No doubt about it. The other one that I'm very, very proud of is that we had 1100 staff members come through 25,000 zone entries, 25,000 tremendous number. And throughout that entire time, not one single staff member was diagnosed with covid. I attribute again, a large part of that too ViSi because through the ViSi solution with many of these patients, we reduced our touches of a patient from 6 to 12 times a day down to 2. That's pretty significant when you're spending that entire shift in PPE as we were. And, uh, and all of the frustrations that come with that and the tendencies for mistakes to happen. Um, it was an amazing number. So zero deaths, zero staff transmissions. All in all, I think it was probably one, if the not the most, successful ultimate care sites nationwide. The customer, in this case, the end customer is Georgia Emergency Management Agency, spoke with them again today about some things. They are extremely pleased with the value that they got the success of the product itself and how well it worked. So much so that we are packaging up the equipment, and one of the things I've got to talk to the Dulayne about is they're wanting to categorize this into a mobile solution, one that could be utilized in a field hospital that they could literally pull it out and get to work with. They believe in the product as well. So, um, one of the best success stories we had dealt with the Dulayne Cumberlander, he was with us literally from beginning to end. There was not a single day that I called him that he did not answer his phone and provide a solution, whatever that was. And in fact, unfortunately, a couple times, that was in the middle of the night, uh, and ended Dulayne performed for as well. So with that, I'd like to turn it over to the Dulayne and, uh, and tell you how much I appreciate everything you did for us here.
Speaker 3: Dulayne Cumberlander, Sotera Wireless
Thanks, Charles. Uh, always appreciative you and always happy to see your face. So thank you. for, you know, sharing that compelling, insightful story of your experience with busy, especially in regards to covid 19. Uh, you know, hearing it from you versus actually being there and seeing it is a different tune and it feels really good. I'm very thankful to have been a part of that. Uh, everyone. My name is Dulayne Cumberlander, and I am the director of business development covering the Southeast in the Midwest, based in Atlanta, Georgia. And truth be told, over the last year, all of us have seen multiple things occur in health care. Um, myself, for instance, whether it be in the hospital and working with Georgia World Congress Center with am I and Charles and his team. Um but, you know, from a professional standpoint, um, it opened up my eyes to exactly how impactful ViSi mobile actually is. And it's it's easy to say that being on my side and being a part of Sotera and and and and working with ViSi, but you truly see another side of going from a hospital to an alternative care facility and using this device. And I say that because it opened up my eyes to how scalable this device actually is. Um, you can actually see it back here on my mannequin, but that is how it looks for the three lead. Um, ViSi a four ounce monitored on the patient's wrist.
But, you know, when I walked into my role, I walked into a role seeing innovation, uh, seeing something that was unique and something that was going to save lives. And, you know, from start to even this point, our target area was the med surg unit. And, you know, we wanted to identify deterioration early on to be able to provide intervention and reduce adverse events. And the numbers have shown it. We have. We have current customers. We have people who have done, you know, test runs with us, and they've been able to catch so many different things. Um, just by being able to monitor heart rate pulse rate, CNIBP continues non-invasive blood pressure, respiration sP02 and skin temp continuously, you bridge the gap that is always missed when you're doing interval monitoring and not saying that that's a bad way, because that is the standard when you go on those monitors for us, but you're giving us surveillance. So to say, um, the piece that was missed. And now you're able to intervene at the right time. But within this last year, I've been able to see that we are able to do so much more than just offer surveillance monitoring for patients to be saved.
We've been able to offer a solution that keeps clinicians safe. Um, obviously, something we know a big deal that occurred over the nation and even worldwide was the limitation of ICU beds. Um, and that's because when you're critically ill treated patient goes into a hospital, they're gonna get admitted to an ICU, bet they're going to need that point of care, and there is no other solution. And even if they try to make alternative care facilities, you're still putting your your clinicians at risk. And having the opportunity to go into the Georgia World Congress Center gave us an opportunity to work alongside Charles and his team can create a whole nother box that we fit into, um and being able to say that we can have finished to be separate from patients, but still, um, you know, hold the integrity of care for that patient the same levels that actually, you bet. Um, And now you offer a solution where we can mitigate patients based on acuity from these ICU beds, open those beds up, put them in an alternative care facility, and still make sure that we're going to keep people from dying, which we see has occurred on a high level over the last year. Um, and, you know, in respect the times we were pushing, uh, about three minutes to have half across the our Excuse me.
I do want to talk a little bit about how we're able to do these things. Um, just real quick, High level. Obviously, we talked about the parameters, and I don't want to limit it to just the continuous vital signs, because we're not just a continuous vital sign monitor. We are an all-in-one surveillance monitoring solution. And with that being said, Charles touched on this a little bit, but with having accelerometers built in, and not only the chest cable or the shoulder center, but we also have built into our actual device that goes on the wrist. This allows us to see the position of the patient at any given time. Reducing falls, reducing pressure ulcers, being able to allow conditions to know when the term patients when that patient falls. If the patient is not supposed to be ambulatory, ended up walking is going to give you the full scope. And not only that, we also do life threatening. Arrhythmia is and I say that and I don't want to say that and confuse anybody. But I want people to understand that not just not only excuse me, are we doing continuous vitals, but we're offering solutions that helps deescalate things like the overuse of telemetry. By offering, uh, let's see an umbrella of care that a position can know, that they have a statement and they can reduce that they can pull or patients off until energy much quicker. And have that that let's say I'm the sky or surveillance to let them know we need to re escalate this patient of some things occurring cardiac related, and you can go on for days and days about what we do. And I don't wanna, you know, overdo it. But just to give you a picture of all the different aspects that we touch on and you know, it was, you know, we went to a situation when Charles reached out and said, Hey, you know, just a timeline.
I spoke with him on Monday. I presented on Tuesday. By Thursday, they sent us appeal, and and I'll never forget Charles saying Hey, the Dulayne, Listen, we gotta go. We were basically a green, light, yellow light, red light type situation. Once I get the green light, we have to be active. And you know, there's that this this project allowed me to see a whole other side, not just myself, but in my team and how much how much my team is gonna put forth to show that this isn't like your the other devices that's going to require infrastructure in time to have to implement. We're gonna put our minds together and figure out work with our customers to make it happen. And sure enough, within three days between delivering equipment, being on site and integrating equipment and also, you know, uh, putting all the pieces together with the monitors itself. Within three days, we we made it happen. Now that was the situation where all the stars align um, so, you know, realistically, there are some things that go in place between meetings and what not? But this is a very quick deployable device. Um, that is unique in its own right, because you won't find anything else. It's out there that can do a complete, you know, solution and be able to solve problems in the speed that we can do it. Um, so you know, that being said, I don't want to overdo it as far as what I can talk about with with our system and myself and my experience, But I do want to open up the floor for for Q and A. I know that we're short on time. So, um, there are already questions.