As a nurse working the floor, I find this article very interesting. I don’t think I fully comprehend how this eICU is designed to function. Does this mean that, in addition to the floor staffing, there will be another 10 nurses who will technically be working the ICU? How can that fly with administration? Or does this mean that because of the remote 10 nurses, the floor staff will be cut to the bone; leaving only a skeleton crew to deal with critically ill patients during emergencies? This, I believe, would make administration very happy.
So, please read this article and let me know how you see this issue. I think I am really confused. I am all for anything that will enable the floor nurse to better care for her/his patient, but I am adamantly against reducing staffing more due to some remote monitoring process.
Shanderia K. Posey
When it comes to caring for patients in intensive care units, there are not enough doctors and nurses to go around.
About 6,000 intensivists – physicians with advanced critical care certification – currently guide the around-the-clock care for ICU patients. More than 30,000 are needed nationwide.
To improve quality of care, hospitals are utilizing a Philips VISICU eICU remote electronic monitoring program proven to reduce mortality by 25 percent. It also reduces complications and hospital cost and shortens a patient’s hospital stay by 1 1/2 days.
The University of Mississippi Medical Center went live with the program – one it calls Intensiview – at 2 p.m. Dec. 15.
The program allows up to 10 nurses and a physician at a time to work out of a north Jackson office to remotely monitor vital signs, view X-rays, review lab work, talk to nurses and patients and evaluate ICU patients with two-way audio and video cameras.
“The camera is so sensitive that we can look at all the numbers on the monitor,” said Terrie Gillespie, director of operations for Intensiview and an acute-care nurse of 26 years. “We can zoom in and read her (a nurse’s) name tag if need be. We can look at pupillary reaction.”
“It’s like being at the bedside with your hands in your pockets,” said Dr. Doug Campbell, director of pulmonary critical care and sleep medicine at UMC.
Each nurse can monitor 30-40 patients 24 hours a day. A physician works from 7 p.m. to 7 a.m. and will monitor 100.
The technology allows the team of critical care specialists to support the bedside care team and to ensure the dayside doctor’s care plans are followed throughout the night.
“I think this is going to be just so much support for nurses on the floor,” said Belinda Birdwell, a critical care nurse of 18 years and a new UMC employee. She worked her first day in the remote office Dec. 16. “They feel like they have a resource person as a backup if they get into a situation.”
For example, an alarm will ring if a patient’s blood pressure drops. If the ICU nurse is attending to another patient and not in the room, an Intensiview nurse can call the unit to have someone check the patient. The Intensiview physician can send in orders for medications immediately instead of ICU nurses taking extra time to find a physician or contact the on-call physician.
Besides acquiring the system to monitor 83 beds at UMC, the program will expand to monitor 24 ICU beds at Delta Regional Medical Center by June.
“Really the mission of all this is to take health care to under-served areas, particularly the Delta,” said Gillespie. “We would like to include hospitals in every area of the state as well as the long-term acute care facilities.”
The Delta Health Alliance provided financial support so UMC could serve the region.
“UMC stands out as the first health system in the nation to initiate an eICU program in partnership with a nonprofit agency like DHA,” said Deb Dominianni, director of corporate communications for Philips VISICU in an e-mail to The Clarion-Ledger. “This is a ground-breaking initiative to improve the health of Delta citizens in what has historically been a medically underserved rural area.”
From other sites where the system was in place, “families do feel a real sense of peace just knowing that, for instance, if the nurse is taken away to do something with another patient that there’s always someone that’s aware of what’s going on with them,” Gillespie said.
Dr. William Pinkston, Intensiview medical director, notes other benefits.
“Smaller hospitals will get more confidence in treating the not-so-sick, (giving them) better utilization of what they have,” Pinkston said. This will lead to fewer patients being transported to larger hospitals and reduce costs.
Being able to remotely monitor patients also will mean patients who do need to be transferred will be identified quicker.
The system will serve as a teaching tool and also build confidence among the bedside care team.
For example, Pinkston worked the first night the system was in place. When the resident physician on the floor called with questions, Pinkston was able to help the new doctor come up with a plan.
ICU nurses get to bounce concerns off of their more experienced colleagues as well. All Intensiview nurses have to have significant critical care experience, Gillespie said.
Even though they are stationary on their shifts evaluating up to five computer screens at once, “it’s still intense,” Birdwell said.
“When you’ve got the number of patients we’ll be taking care of, it’s gonna be constant.”
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