- Emory Healthcare is testing a telehealth platform that ensures patients in ICUs at any location and any time have immediate access to a clinician at the top of his or her game.
To do this, the Atlanta-based health system is partnering with Royal Philips and Macquarie University in Sydney, Australia, to create an eICU network that ensures that ICUs in the Emory network are staffed at all times by Emory doctors and nurses on normal daytime shifts.
If successful, the program could someday lead to the creation of a global network of ICUs, all connected by a telehealth platform.
“There are very few people who are truly nocturnal,” says Timothy G. Buchman, MD, PhD, director of the Emory Critical Care Center and chief of the health systems critical care service, who developed and launched the ongoing six-month project. More importantly, he says, ICU staff need to be top-notch and fully awake because they’re dealing with the sickest of the sick, and the most complicated patients in a hospital.
The project puts a couple of healthcare theories to the test. One is that the level and quality of care drop during a hospital’s off-hours, when clinicians aren’t at their best or most awake. The second is that off-hours shifts are often staffed by young and less experienced doctors and nurses, those who need the extra hours or don’t have the seniority to avoid them.
Indeed, studies have shown a sharp drop-off in clinical outcomes for patients treated off-hours, compared to those treated during the day. Conversely, studies have shown that eICU programs improve patient survival rates by some 26 percent over traditional ICU programs, with a 20 percent faster discharge rate.
There’s also a financial benefit. Health systems often have difficulty staffing off-hours shifts, and have to offer bonuses or extra benefits as enticements, adding greatly to a hospital’s bottom line.
Buchman and Cheryl Hiddleson, MSN, RN, CCRN-E, director of Emory’s eICU Center, say they wanted to get around these issues by making sure the health system’s eICU network – which serves several hospitals, some as far away as 250 miles – is staffed by fully qualified personnel. Sending them to Australia, some 14 time zones away, fit that bill to a tee.
Because when it’s nighttime in Atlanta, it’s daytime in Sydney.
“There’s a lot of trust involved when you’ve got a really complicated, sick patient about to go off the rails,” says Buchman, who wanted the program staffed by Emory personnel rather than having the health system contract with a telehealth vendor or other health system to provide off-hours coverage. We wanted to make sure there’s an Emory Health [doctor or nurse] at both ends of the line.”
Hiddleson says the program, roughly halfway through its six-month stretch [they’ll take some time off during the Christmas season, to give staff a chance to come home for the holidays], had to overcome a number of technical, legal and organizational hurdles. They had to make sure the audio-visual connections were good and strong, so that clinicians could not only treat patients but use a separate link to collaborate with staff at the site.
“You’re talking about an eICU (network) that gives you an air traffic control view of doctors and patients … literally at the speed of light and the touch of a button,” Buchman points out. “That second layer of support has to be as good as the first.”
In addition, Hiddleson says the MPLS network is hosted on Emory’s platform, with no data stored at the Australian end [avoiding any HIPAA concerns]. And by having credentialed Emory doctors and nurses stationed in Australia, she notes, they didn’t have to jump through any additional licensing and credentialing hoops.
Buchman says the eICU model has proven popular at Macquarie’s MQ Health, the nation’s first university-led integrated health campus. It's attracting interest not only from Australian health officials, but others across Asia.
“We aim to transform the delivery of care to address growing clinician shortages while improving patient outcomes,” Kevin Barrow, managing director for Royal Philips’ Australia and New Zealand operations, in comments accompanying the program’s launch. “I am confident that the application of these kinds of solutions will shape the future of healthcare. If we are able to do this across continents we can certainly replicate it locally, connecting Australian clinicians with patients in need across regional and remote areas.”
Buchman and Hiddleson say there’s no shortage of clinicians wanting to take part in the program [really – it’s Australia], and they’ve been able to create a program whereby four doctors and three nurses are working in shifts of six to nine weeks. Buchman says it has proven less expensive to pay for plane tickets and apartments in Sydney, as well as paying the doctors and nurses involved, than it would be to fund an off-hours telenocturnist program for the health system’s ICUs in the states.
If the program proves successful – it concludes next spring, at which time it will be evaluated – Buchman says Emory could branch out to more ICUs, even more areas of the hospital, and create a branded business model around it. He sees other health systems using the same model, and Hiddleson envisions a global “co-op” of health systems creating a platform that makes sure it’s always the middle of the day for clinicians working in an ICU.
“It points to how common the challenges are for healthcare worldwide,” Buchman says. “And we’ve found a way to solve one of the biggest ones.”