E-ICU Systems Provide a New Level of Care to Patients

Imagine a setting in which you are taking care of a patient and miles away a staff of intensivists and critical care nurses are double-checking medications and tracking vital signs, all in the name of improving patient care. This is the goal of the pioneering telemedicine program, the E-intensive care unit (ICU). The E-ICU system improves patient care and supports bedside nurses, according to Debra Perdue, a critical care nurse at Mercy Health Center in Oklahoma City. In the wake of a healthcare crisis in which patients outnumber medical staff, a severe shortage of bedside intensivists exists, and 1 out of every 5 hospital deaths are the result of medical errors or sentinel events, the E-ICU provides extra pairs of eyes to monitor patients and respond to emergencies.

“Caregivers will not be replaced by telemedicine, but will have technology readily available to assist with providing comprehensive, quality care,” Perdue said.

Making the Transition

Installing the technology incorporated in an E-ICU is an expensive venture because the cost is not transferred to the patient. Participating hospitals underwent numerous technological advances to incorporate the E-ICU system. In-room computers, high-speed data lines and direct phone lines were installed to create direct communication between bedside medical staff and the E-ICU board-certified intensivists and experienced critical care nurses. In-room audio and camera, video connections and emergency contact buttons allow the E-ICU team to monitor patients in real time. Both the bedside staff and the E-ICU staff are legally responsible for the care of the patients and E-ICU staff must be certified for all states in which they monitor patients.

Perdue touted the benefits of the E-ICU system, but confessed that the transition was not an easy one. Staff had to be trained on the system, while policies, procedures and workflows had to be developed around the new technology. Many nurses experienced a learning curve in using the paperless documentation system. In addition, bedside physicians and nurses resisted the change at first.

“We felt like we were treating the computer instead of the patient,” Perdue said.

Bedside staffs were also concerned that the constant audio and video stream would create a “Big Brother” mentality in which their every move would be recorded. However, the video and audio equipment has no recording capabilities.

Improving Care

After the incorporation of the E-ICU, hospitals have seen an increased number of intensivists at patients’ bedsides and an increased number of lives saved. Mortality rates, number of codes and ICU lengths of stay have all decreased since the implementation of the E-ICU system. This, in turn, has increased nurse confidence and many new grads have found the system particularly helpful, Perdue said. It has even improved nurse recruitment and decreased turnover in the workplace.

The E-ICU uses a system comprising three levels of care and three levels of patient acuity. At level 1 care, the E-ICU team intervenes in life threatening events, such as cardiac arrest. At level 2, the team can write orders by consulting with bedside physicians. At level 3, the team maintains locally prescribed current treatment and institutes new therapies as clinical conditions change. Patient acuity levels include red, yellow and green, representing high, medium and low risk, respectively.

The VISICU E-ICU system, used by the Mercy Safewatch team, was developed in 1998 by Drs. Michael Breslow and Brian Rosenfeld who managed the Adult Critical Care Unit at John Hopkins Hospital. The E-ICU command center, located in St. Louis, monitors beds in hospitals across Oklahoma, Kansas, Arkansas and Missouri.