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Remote Control

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Back in 2000, Sentara Healthcare gambled on a development project with an upstart technology vendor. The vendor, Visicu, needed a beta partner for a remote monitoring system for patients in the intensive care unit. Faced with a looming shortage of intensivists, Sentara signed on.

Now, seven years later, executives at the Norfolk, VA-based hospital system say the technology has exceeded expectations. The “electronic ICU” enables a small team of physicians and nurses to monitor 105 beds in 11 ICU departments across six hospitals up to 120 miles apart. The telemedicine setup does not replace bedside care, nor supplant local creation of treatment plans. It does, however, improve care delivery, resulting in shortened lengths of stay for ICU patients and lower mortality rates. “The eICU adds an additional layer of monitoring and surveillance,” says Gary Yates, MD, chief medical officer. “We can more quickly identify patients who are beginning to deteriorate.”

The eICU’s “command center” is located at Sentara Norfolk General Hospital. Staffed by a standard crew of one physician intensivist, two critical care nurses and one administrative support person, the center serves as a hub for multiple data feeds from the health system’s ICUs, Yates explains. Patient demographics and data from local cardiac monitors and lab and pharmacy systems flow into the Visicu monitoring center. The software can identify changes in a patient’s condition, factoring in diagnosis, lab values and other variables. As they conduct their “virtual rounds,” clinicians in the command center can use the system to view Sentara’s entire ICU census and then analyze individual patient data, which is color-coded to acuity level. The color cues remind clinicians when to check on individuals.

Unlike common ICU alerting technologies, the eICU can monitor data for trends. Rather than just warning that a certain value has been hit, the software identifies patterns and combinations of factors that suggest patients are poised for a downfall. For example, a combination of a certain lab value, medication regimen and blood pressure reading might trigger an alert, which would be acted on by the clinical staff in the eICU, says Kristen Clickner, RN, director of information technology.

The monitoring center runs 19 hours a day, noon to 7 a.m. During the off hours, there are adequate intensivists and other physicians patrolling the various intensive care units, Yates explains. It costs about $2 million annually to run the unit, Yates says, with the majority of the expense going to salaries. But having a small group monitor a large number of patients is a good way to use technology to leverage the skills of clinicians in short supply, he adds.

Initially, some physicians feared the remote monitoring setup would impede the doctor-patient relationship, Yates acknowledges. But as physicians learned how a centralized alerting system can improve care, they accepted the new technology. “You are able to monitor the care plan on a more frequent basis,” he says. “After six years in operation, we still have a 15 percent annual decrease in mortality compared to baseline. More than 100 patients a year leave the remotely monitored ICUs and go home who might not have before.”

The main hurdle in setting up the remote monitoring unit was getting the multiple data feeds to work in harmony, Clickner says. The interface to the medication and lab systems was easier thanks to using HL7 standards, she says, but linking in cardiac monitors was more challenging. The system’s video feed—which lets physicians in the eICU examine a patient if needed—was also difficult to set up. “Typically, the monitors were maintained by clinical engineering,” she says. “Now IT has to get involved if new monitors are ordered. Everyone used to live in their own little world. Now we are sharing.”

—Gary Baldwin