How Nemours Children’s Health System Leverages Video Integration to Deliver Better Patient Care
In addition to traditional security and monitoring functions, Nemours Children’s Hospital uses its video management platform to deliver unique services to the radiology and cardiology units, behavioral health clinics, perinatal care and more.
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Technology and video integration play an important role in Nemours Children’s Health System’s services. With more than 1,800 network cameras, the hospital not only uses video for surveillance, security and situational awareness throughout the interior and exterior of the facilities, it also uses this technology to improve patient care by delivering services to the radiology and cardiology units, behavioral health clinics, perinatal care and more. All of this functionality is anchored by video management software (VMS), specifically the scalable Milestone XProtect Corporate open platform VMS.
The hospital has two command centers with traditional operators acknowledging alarms, monitoring in real-time, performing investigations and other forensic work. Additionally, the Nemours Tactical Logistics Center (TLC) serves as mission control for the hospital video system. With 16 large monitors, every child-patient can be seen on-screen along with their data, local news, weather and communications from surrounding hospitals. If there’s a mass casualty drill or an actual emergency, officials can make real-time decisions on routing traffic or patients to or from other hospitals. Also, if needed, TLC can capture video from the displays and rebroadcast the data to hospital leadership for additional direction.
Cameras Deployed in Non-Traditional Way
In addition to their video surveillance system’s traditional security functions, Nemours uses their cameras in many other ways, including a range of integrations that help the hospital improve facility efficiency, lower operational costs and deliver a safe, pleasant and healthful patient experience.
Campus at a GlanceHospital: The Nemours Children’s Health System is a national organization that provides pediatric medical care, research, education, prevention and advocacy. It is one of the largest integrated children’s health systems in the United States.Location: Nemours owns and operates two free-standing children’s hospitals: the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, and the Nemours Children’s Hospital in Orlando, Florida, along with outpatient facilities in five states.
Campus Size: The Orlando facility is a full-service, 100-bed hospital with emergency care.
Video Management Platform: Milestone XProtect Corporate open platform VMS.
With child safety foremost in mind, Nemours has deployed a camera in every patient room. This allows for a level of monitoring that a patient wouldn’t normally have in place. Not only are there nurses and clinical staff in the room and at the nursing station, but the TLC is able to announce themselves via audio and then monitor a room. This gives them the ability to assist remotely and call other rapid response teams if there is a medical emergency.
“We have an AXIS P33 Series fixed network camera in each room to provide a third level of patient monitoring and situational awareness within the patient envelope,” says Nemours Technical Architect Joe Summanen. “None of the camera outputs are recorded, but when an alarm trigger is activated, it allows highly trained paramedics to monitor every child at Nemours 24/7. This capability has greatly extended our patient coverage and has allowed us to provide more effective and cost-efficient care.”
Each patient room camera is equipped with a privacy LED light indicator. The hospital uses a range of LED notification solutions, some triggered by the Milestone VMS and some by the AXIS camera itself. When anyone is accessing the video, the LED will flash, letting those in the room know that the camera is in use. Only authorized personnel are allowed access to the video.
As a data foundation for the system, the hospital keeps tabs on patients through video integrated with Epic Monitor. Epic is the hospital’s electronic medical records (EMR) system. An EMR is a digital version of the patient’s medical chart. By tying the information to the logistics center, operators can keep a vigilant watch on patients with their medical information data also presented on screen. This detail allows operators to stay informed and keep a close eye on the most critical patients, including patients with behavioral health issues and autism.
Along with the cameras, Nemours uses a mix of video/data integrations and analytic tools to extend the effectiveness of human operators by quickly flagging potential issues. Milestone’s open platform VMS enables other systems to share video and data.
“Several clinical groups within Nemours use our Milestone system regularly, including cardiology and in our ORs,” says Summanen.
Remote Video Delivers ‘Wet Reads’ for Fetal Care
The perinatal department also uses the Milestone platform to share video of ultrasound scans with others located throughout the region for real-time “wet reads” of the imaging. (A wet read is a reference to reading an x-ray immediately following the processing of the film — i.e., while it is still wet from hand processing.)
“When a technician is performing an ultrasound scan, they can share the scan video with others remotely if needed,” says Summanen. “This can be done live, giving the provider immediate feedback. A diagnostic-level reading is still forthcoming, but the immediate sharing allows us to provide a more thorough service and perhaps save the patient from additional ultrasound scans.”
For example, a technician may notice an abnormality in a scan and want to share the live video with a perinatal specialist in real-time, who may be at a remote location.
“Remote video offers a great level of efficiency for our care providers because they don’t have to leave the hospital and go to another location; they have the ability to provide guidance to the ultrasound technician remotely,” says Summanen. “It’s another tool that we can provide to our associates and to our clinical staff to help them connect with families and provide better care more quickly.”
Cardiac Unit Benefits from System
Another use of video is with the cardiac unit, which encodes every physiological monitor in the cardiac unit with the information integrated on the VMS displays, allowing cardiac intensivists to monitor patients around the clock. Also, with remote connectivity through the Milestone XProtect Smart Client, if the cardiologists are home or traveling, they can quickly check in on patients through their smartphones or mobile devices.
When connecting with the XProtect client remotely, a care provider can look at all the physiological monitors within his or her unit, keeping all their patients top of mind. The video system has had a very positive impact and has helped reshape how they are providing care.
“Something that has always resonated with me was feedback I received from several providers about how they are now able to monitor and check on their kids’ physiological monitors when they are at their desk or even at home,” says Summanen. “By always being present in their day-to-day life, they’re now thinking about the care of those children all the time. It’s really changing the model of care here at Nemours.”
Cameras Help Manage Behavioral Care
With the Orlando Behavioral Health unit, video is used primarily as a clinician tool to allow multiple people — often including the parents — to observe a patient session without causing the child additional stress or distraction. Also common is for the clinician to have a set of tasks for the parents to work through with their child in the room, and video records the family as they address the tasks together.
The Nemours Applied Behavior Analysis team was looking for a way to help teach skills to patients with behavior deficits or issues of inappropriate behavior, such as tantrums or self-injurious actions, and to help the patient adopt more appropriate conduct. The skill development and training is a valuable tool for staff, parents and other family members as well.
“Problem behavior is often difficult for parents to see,” says Ansley Hodges, lead behavior analyst at Nemours Hospital. “The cameras make it easy because parents can sit with me in my office as we watch the therapist at work with the patient. I explain what the therapist is doing and why, and the parents can start to see that. Then they think ‘OK; this might look bad but the patient is responding and making improvement.’”
Hodges adds that the same concept applies to new skills when instructing patients on how to communicate more effectively. Here, cameras and recorded video are an efficient way to illustrate and reinforce desired behaviors. The capability has been a huge game changer for the hospital’s autism clinic.
“We’ve received such great feedback from parents and our staff about how helpful the video is,” says Hodges. “Parents feel more confident in leaving their child in our care because they know that we’re monitoring everything very closely. Some patients are here for 30 hours a week, and at any point in time, we can review specific events or simply observe their progress.”
According to Summanen, upon parental approval, live session video is also used for staff and student observation and training purposes. Each room features an LED indicator, so the parents or clinician know when they are or are not being observed.
Video Solution Provides Flexible, Open Integrations
Nemours has utilized the Milestone platform for several years, and Summanen is highly complementary of the solution because it’s user friendly and flexible.
“The Milestone open platform allows me the flexibility to source and integrate third-party products and capabilities, which enables us to greatly expand and customize the tools and services that we provide to the organization and our patients,” he says.
For example, Summanen found the UK-based company, Antrica, a manufacturer and supplier of H.264 and H.265 hardware, who offered a video encoder solution that the Nemours team was interested in working with. Summanen contacted their lead engineer and explained that he wanted to integrate their system with the Milestone VMS, and it was no problem.
“The engineer contacted Milestone, and within a few weeks, they were able to write a new codec into the Milestone driver pack — and now it’s part of the driver pack that’s released with every Milestone product,” said Summanen. “The entire process was just so simple. At the end of the day, when you have a great partner, it’s easy to be innovative and successful.”
Barbara Rizzatti is Milestone’s communications manager for the Americas.
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