Mon May 6, 2013
Intensive Care Specialists 'See The Patient' From A High-Tech Desk
Starting this week, patients in critical condition at three Charlotte hospitals will have an extra set of eyes watching over them. That's because Carolinas HealthCare System is rolling out a sort of virtual command center in Mint Hill. From there, intensive care specialists will monitor patients.
Nurse Chelsea Cardona will soon have a new way of introducing herself to patients. She'll be talking to them in Mint Hill from what's called a virtual ICU.
"We'll have six screens in front of us," she said. "Those screens will monitor vital signs. They will monitor critical lab values."
And one screen has a sort of suped up version of Skype. In a demo, Cardona showed video of a patient's room and moved the camera with a few clicks.
"We can look at pretty much anything in the room and zoom in fairly quickly to see the patient," she said.
The patient will also be able to see and hear the nurse in the virtual ICU.
"If the patient is awake and alert, not sedated on a ventilator, they can definitely talk back to us," she said. "They can also see us on the camera."
It's almost like having another nurse in the room. Cardona said she can pull up the bedside nurse's notes, track vital signs, "and I can also look on the patient e-care manager and make sure everything looks OK."
Basically, she has everything she would have if she were actually at the bedside.
"And more," she said. "At the bedside we see their blood pressure. We see their heart rate. But we're not able to trend that over a long period of time and notice the subtle changes in patients. The subtle changes in intensive care are what really save lives."
It can be easy to miss a slight drop in blood pressure in the chaos of an ICU. But in the virtual one, Cardona will be a step removed.
She'll have two other nurses and a doctor set up next to her, all of whom are intensive care specialists. Vice President of Critical Care Colleen Hole said that's "essentially a care team: three nurses and a doctor in four stations."
Hole said the virtual ICU will eventually have four of those teams, each covering about 120 patients.
"This technology has proven to reduce mortality anywhere it's been implemented appropriately," she said. "Mortality decreases, length of stay decreases and complications decrease."
A national nonprofit that monitors hospital quality and safety backs up that claim about virtual ICUs, also called eICUs. Leah Binder is CEO of The Leapfrog Group.
"They can really save lives," Binder said. "The eICU programs that we've seen across the country really do help manage very complex, very sick people in ICUs."
Virtual ICUs have been around about a decade. Brian Rosenfeld co-founded the company that built the first one. Now he's a vice president of Telehealth at Philips, which has helped set up more than 50 virtual ICUs across the country.
"They cover roughly 450 hospitals, probably over 10,000 adult ICU beds, which is some 12 to 13 percent of the adult ICU market in the U.S.," Rosenfeld said.
For Carolinas HealthCare System, the initial investment is nearly $12.5 million dollars. But the virtual ICU won't replace doctors or nurses, said chief academic officer Dr. Jim McDeavitt.
"We're not displacing doctors," he said. "We are adding a doctor, adding a new brain to the care delivery system that doesn't exist in most of these hospitals today."
Of course, all this technology only works if the nurses in hospitals are responsive to the specialists on a video screen telling them what to do.
"There's challenges in any kind of long-distance communication," said Connie Barden, former president of the American Association of Critical-Care Nurses. Now she's one of the leaders of a virtual ICU in Miami.
She said it can be tough to build trust through video, "so we constantly work on relationships between the virtual ICU and the folks at the bedside."
One of the ways Carolinas HealthCare System is addressing that is through its rotations - the nurses and doctors at the virtual ICU will all have shifts at the hospitals they cover. That way they reconnect in person with the people they'll now be working with through video.
The virtual ICU will open this week for CMC-Pineville, University and Mercy hospitals. By the end of this month, it'll expand to CMC-Union, CMC-Lincoln, and regional medical centers in Cleveland and Stanly counties.