- Treatment of patients in intensive care units (ICUs) makes up about one third of all hospital costs in the US. These patients are sick. They’re running IVs, ventilators, monitors, and procedures that are not found on a Med-Surg floor. And each patient responds differently — the sickest patients are more likely to require rapid intervention for problems like arrhythmia, hypotension, hypoxia, or sepsis.
A remote ICU is set up to recognize and tend to these problems quickly. The patient has an intensivist MD monitoring the chart and receiving alerts of shifts in the patient’s condition as well as a video and audio feed into the room. The MD can see and talk to the patient, zoom in and read the vent settings on the device, and alert the floor nurse that the patient needs hands-on care.
Multiple ICUs can be monitored at one remote site. With one intensivist and ICU nurses rotating into the center, the patient monitoring load can be dispersed. By running the center at night when staff is usually reduced in the units and hospitalist are covering the patients, the remote ICU puts an intensivist caring for the sickest patients. This stretches the skills of the Intensivist over more of the hospital’s ICU patients. There is a powerful influence on the quality of patient care with the presence of a critical care physician monitoring these patients all night long.
Consider this scenario: A 77 year-old patient is asleep in the ICU. The floor nurse is down the hall caring for another patient. Suddenly his blood pressure and breathing becomes erratic. Alerts are firing in the remote ICU that attracts the attention of the remote ICU staff. They pull up a screen that graphs the vital signs and shows the values from the monitor. Suspecting the patient is falling into arrhythmia, the Remote nurse calls the attention of the Intensivist. The MD looks at the patient and pages the floor nurse to the room. With the MD on the video conference, the medication is changed and the patient is resting comfortably again.
One of the barriers to setting this up is that the bedside doctors and nurses do not understand how the system works. There is also a fear that the remote center is trying to “take over” or criticize what they are doing. But in reality, it is providing improved safety through redundancy and enhancing outcomes. They provide a supportive role. They have an overview of the patients and partner with the floor staff by helping them care for the patients. Also, rotating floor staff in and out reduces some of the fears and promotes the education on the value to the patients and staff.
More than a decade ago, Remote ICUs were being talked about as a way to provide better care for the very sick patients. But studies show that the implementation of this idea has stalled. Statistics, however, show that the Remote ICU saves lives. Death rates in ICU have dropped. In checking 3 sites the death rates dropped from 4–20%. LOS in the ICU declined by 1-3 days.
With the Baby Boomer generation reaching 70, a greater demand will be placed on ICUs. By utilizing advanced medical imaging, video conferencing, and computer software technology, the specialists can monitor intensive care patients and provide a higher quality of care.
Cheryl King is an Epic Consultant at Innovative Consulting Group.