High-Tech TLC
High-Tech TLC | Nemours Children’s Hospital, The Logistics Center, Daniela Melendez, Dr. Al Torres, Nicole Johnson.

Nemours’ new Clinical Logistics Center works ‘like well-oiled machine’

When examining a patient in a room at Nemours Children’s Hospital, a nurse in the medical/surgery unit discovered her young charge was having difficulty breathing, and discreetly pushed the orange Rapid Response Team (RRT) button on a panel in the room.

“It’s going to revolutionize the way we provide healthcare in Florida.” –Al Torres, MD, chief of critical care and medical director of clinical logistics for Nemours Children’s Hospital.

With that instantaneous motion, the nurse summoned highly-trained paramedics to monitor the patient’s vital signs, while also viewing their electronic medical record. The call-to-action could have resulted in various actions, including requesting radiology bedside, initiating a transfer, or summoning a doctor.
From day one, The Logistics Center (TLC) at Nemours has worked “like a well-oiled machine,” said Daniela Melendez, nurse manager for TLC’s Clinical Operations Center at Nemours.

Another example of TLC in action: a young boy with chronic kidney disease (CKD) had been at Nemours for several days when paramedics noticed the Phillips cardiac monitor began displaying arrhythmias. A physician completed a quick bedside assessment and ordered labs, which showed a high level of potassium, a common side effect in CKD patients. Medication was administered to bring down the patient’s potassium level.
“No pediatric hospital in Florida has a facility like this one,” said Melendez. “Some adult facilities have remote monitoring with video capability for adult ICUs monitored by physicians. Our facility is pediatric-specific. It’s amazing!”
TLC is located inside the new academic, freestanding children’s hospital that opened Oct. 22 in Lake Nona Medical City. The 137-bed children’s hospital –  the total number of beds will top 250 when the second phase is completed – houses critical care services including 10 PICU beds, 13 NICU beds, and expansion for up to 46 ICU beds on the third floor.

“The basic idea of TLC is like a command (center) you’d find at an airport or on a cruise ship,” said Al Torres, MD, chief of critical care and medical director of clinical logistics for Nemours. “Besides communication and security, which are obviously very important to the hospital, we also have clinical logistics so every child is monitored. We have highly trained paramedics who watch the children 24/7 and act like the eyes and ears for nurses when they’re not with patients.”
The creation of TLC was made well before the hospital was built. “Our leaders wanted to make a huge difference, and by not making TLC remote and also by adding the clinical logistics backup component, they did just that,” said Melendez.

Nicole Johnson, RN, MSN, director of emergency room services for clinical logistics, explained that many organizations claim a central information hub.
“This (particular) concept is revolutionary for healthcare,” she said. “We’re taking info from all over hospital into one place, integrating it through technology, and pushing it back to the bedside nurses to help them provide better care. When children come into a hospital, depending on their vital signs and diagnosis, clinical logistics will look over them a little more carefully.”
Alerts outside predetermined parameters go to a nurse’s handheld device. If the nurse is in the middle of a task, such as starting an IV on a patient, clinical logistics will activate their protocols to involve other medical professionals.

“Our EMR incorporates lots of information – lab work, patient history, specialty clinic reports – that paramedics can see by signing into one area. It has the ability to pull data from the patient’s record and display it in a way that makes it easy to follow, spot trends, and identify problems,” said Torres. “It’s going to revolutionize the way we provide healthcare in Florida.”
When Melendez gave a presentation of TLC’s capabilities – and its potential outside the medical/surgery unit – as a safety mechanism for pediatric patients to the Family Advisory Council, one of the first remarks was, “Oh, so I’m going to be videoed all the time?”
“I clarify that no, the only time video is turned on in the room is when the child’s health is in danger,” she said. “It’s not a situation where Big Brother is watching all the time.”
Torres has been impressed by TLC’s effectiveness.

“It’s nice to know when I’m not here, someone’s watching,” he said. 
Melendez, a mother of 10-year-old Amber and 5-year-old Jorge (pronounced George), who has asthma complicated by allergies, said she’s relieved to know TLC has a bird’s eye view.
“We’ve not had to be admitted yet for my son’s asthma, but I imagine our luck will run out one of these days,” she said. “If he’s here, he’ll absolutely be in great hands. TLC will never replace nurses or the human touch. It’s just another way to make sure the kids we’re caring for are safe and getting the best care. Everyone would be taking part in their safety and care, and I don’t see how with this plan anything could be missed.”