WakeMed opens remote center for monitoring intensive care patients

jprice@newsobserver.comSeptember 5, 2012 

— With a couple of keystrokes, critically ill patients at WakeMed’s Raleigh and Cary hospitals suddenly had more doctors and nurses watching over them – albeit from miles away – as the hospital system took a step into what many health care professionals think is the future of intensive care medicine.

WakeMed’s tele-ICU, in an office building off Atlantic Avenue, went live Wednesday. There, nurses and doctors trained in intensive care use banks of computer screens, audio, video and a stream of data such as X-rays and real-time vital signs to monitor patients 24 hours a day, working as a team with the doctors and nurses at bedside.

WakeMed administrators say they expect the new facility, the first of its kind in the Triangle and which they call an eICU, will provide an extra layer of patient monitoring and care that will save lives, reduce complications, shorten ICU stays and cut costs.

“I like to think about this as being like air traffic control,” said nurse Chris Smith, manager of clinical operations for WakeMed’s eICU Service. “We’re watching over everybody and keeping everything safe and on track.”

Typically, tele-ICUs are built by a hospital system to serve ICUs at several hospitals. WakeMed administrators believe theirs is one of just two in the state, with the first being at Cone Health in Greensboro. At least a few hospitals in the state are contracting for similar services from elsewhere. High Point Regional Health System has contracted with a St. Louis tele-ICU for three years.

Around the country, tele-ICUs are rapidly becoming more common. A spokeswoman for Philips Healthcare, which equipped WakeMed’s, says the company opened its first 11 years ago in Norfolk. Since then, more than 400 hospitals across the country have become linked to more than 40 centralized tele-ICUs. In some cases, more than 20 hospitals in one system are linked to a single ICU.

While some studies of tele-ICUs have shown little benefit, others – including a large one that appeared last year in the Journal of the American Medical Association – have concluded otherwise, said Dr. Clifford S. Deutschman, president of the national Society of Critical Care Medicine.

Deutschman, who works in intensive care at the Hospital of the University of Pennsylvania, which has a tele-ICU, said he was skeptical about them initially, but has warmed to the idea.

“It’s promising, it’s important, it’s designed to address a big problem, and it’s certainly worthy of careful study and review,” he said.

Conflicting opinions

It will be impossible to replace doctors, he said, and not everyone is sold on the concept. But it can help ensure that best practices are followed, by, for example, triggering automatic reminders to ensure that certain life-saving therapies are considered in cases where they may have been overlooked.

Deutschman said all of the studies he had read on the topic had potential flaws, but the JAMA study, which followed almost 6,300 adult patients in seven ICUs at one large teaching hospital, seemed solid. It measured a nearly 2 percent drop in mortality, fewer complications and a drop in the average hospital stay from 13.3 days to 9.8 days.

Such outcomes are great for patients, but they also can improve the hospital’s bottom line: Medicare and other payers limit the amount they’ll pay for ICU stays, and the pressure to hold down the number of days a patient spends in an ICU bed is expected to grow.

WakeMed is counting on those savings to help offset the added costs of the tele-ICU, a new layer of care that won’t displace any of the healthcare team on the floors of its seven ICUs.

A study published last month in the journal Chest found that it cost $50,000 to $100,000 per bed to start and run a tele-ICU in the first year. The effect on costs per patient ranged from a $3,000 reduction to a $5,600 increase.

Tele-ICUs also can help hospitals cope with a national shortage of specially trained intensive-care doctors and nurses, particularly small hospitals in remote areas or those in places where it can be hard to recruit doctors for other reasons. Tele-ICUs can provide services to hospitals hundreds of miles away.

This is a boon to those smaller hospitals that might have a doctor trained in intensive care for only part of the day. If nurses need to consult with one, all they have to do is push a button to alert the tele-ICU.

And even in larger hospitals, that call button can make response to an emergency quicker, as a nurse can hit the button and consult immediately with a doctor, rather than having to page the doctor on duty in the ICU.

Another benefit to the hospital by getting into tele-ICU early is positioning itself for the future, said Dr. Bill Lane, an intensivist who worked with Cone Health’s tele-ICU for three years and now is the medical director for WakeMed’s. Eventually the service could be used in other departments at WakeMed and offered under contract to hospitals elsewhere.

Spokesmen for UNC Health Care and Duke Medicine said they have similarly sophisticated hardware and software for monitoring patients in their ICUs and are confident that their staffs are large enough to provide top-flight care.

Duke is finishing a new critical care tower designed to accommodate a tele-ICU if it decides at some point that the idea fits its needs, said Dr. Thomas Owens, chief medical officer.

The conflicting study results and the wide variation in models for how ICU’s are operated make the picture murky right now, but the hospital system’s leaders are carefully following the concept. Of particular interest is how good the software will get at studying the mix of incoming data and predicting likely changes in a patient’s condition, he said.

Now, patients and their families expect substantive, face-to-face interactions with their health care team, Owens said. If Duke decides to use a tele-ICU, he said, a key goal would be making sure those interactions weren’t harmed.

“I’m not saying that (tele-ICUs) do that now, just that we would need to be careful of it,” he said.

WakeMed’s eICU works like this: typically it will be staffed with two nurses who have at least five years of experience in ICUs, and a doctor who is board certified in intensive care work. The nurses will each sit at a bank of six screens checking on one patient at a time each.

They will work 12-hour shifts like nurses in the hospital, though their shift changes won’t coincide with those for nurses at the hospitals.

The six-monitor stations can be raised to let the nurses work on their feet awhile. In the corner is a treadmill to help with an energy boost if they need it.

Color-coded priorities

Patients most at risk are designated “red” and checked on at least once an hour. “Yellow” patients will be checked at least once every two hours, and those in stable condition are tagged “green” and are checked at least once in four hours. None of the audio or video is recorded, and patients and their families are warned by a chime when the video camera in the room is about to go live. In their ICU room, a screen shows them an image of the doctor or nurse in the eICU, and they can converse.

On Tuesday, while the eICU team was working on the last details before going live, Jerry Pearce, a registered nurse, used the camera to check in with patient Fred Hamilton, 78, of Garner, who had been admitted four days earlier with shortness of breath.

The video camera is powerful; Pearce was able to zoom in so close that it was obvious Hamilton’s pupils weren’t dilated. Pearce then shifted the camera to Hamilton’s hospital wristband, which was easily readable.

Other screens showed that an X-ray of Hamilton’s chest, his medical chart and vital signs including the amount of oxygen in his blood, respiration and heart rate, steady at about round 89 beats per minute.

Pearce told Hamilton and a nurse also in the ICU room that he was turning off the camera, and Hamilton cheerfully waved goodbye. It was almost time for him to check out.

Price: 919-829-4526

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