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New ICU technology could improve IC processes


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Two-way camera feeds provide additional support for bedside staff members

After reading this article, you will be able to:

  • Explain how the eICU works
  • Indicate ways the eICU can help with IC compliance
  • Define Alegent’s rules regarding the communication between the eICU and bedside staff members

Imagine you could interact with multiple patients, diagnose and treat their illnesses, administer drugs, and even ensure that medical staff members are following IC best practices 24 hours per day, seven days per week, all without getting out of your chair.

This is the basic premise of the eICU, an electronic subdivision of the ICU at Alegent Health in Omaha, NE. Mark Kestner, MD, senior vice president and chief medical officer at Alegent Health, likens it to an air traffic control tower. Nurses and physicians man an off-site location filled with two-way cameras linked to ICUs in three metropolitan hospitals and one rural hospital in the system.

Six nurses in the eICU routinely manage 15–20 patients each, in conjunction with on-site ICU staff members. A physician handles high-risk patients, and Alegent recently added a pharmacist to monitor antimicrobial activity.

The software built into the eICU not only feeds real time data for roughly 100 patients, including vital signs, laboratory tests, cultures, and pharmacy data; it also sorts the information and sets off alerts if there are concerns with a patient. Doctors and nurses in the eICU can also alert bedside medical staff members if a patient needs emergency care.

“What it does is it frees up the bedside staff because they know that certain elements of information are being sorted and addressed and that they can then be more available for the immediate needs of the patients or the routine bedside needs of the patient,” Kestner says.

But from an IC perspective, it also provides a window to monitor compliance and effectively implement infection prevention bundles in a unit that is notoriously battling infections.

Involving IC

In its first two years, the eICU at Alegent has focused primarily on patient care, but Emily Hawkins, RN, BSN, director of IC at Alegent Health, says the centralized location of the eICU makes it a great opportunity to integrate infection prevention compliance, as well.

A pharmacist has already been incorporated into the eICU to monitor drug interaction, but Hawkins says there are also plans to use the eICU to build antimicrobial reviews, which will forward information to the lab and pharmacy. Going forward, an infectious disease physician will be present to intervene with antimicrobial counsel.

The eICU team is already incorporating ventilator and central line bundles into its everyday care.

“I think what this allows us to do is to standardize our compliance with ventilator bundles and with standards of care,” Kestner says. “We already had a very low infection rate, but this allows us to have another set of eyes on the team asking very specific questions every day. The eICU team does have the checklists and they make sure the central line is taken out if it’s not needed, the ventilator bundles are adhered to, the patient’s head of the bed is up, and the patient is being excubated quickly if they don’t need to be on the ventilator.”

It also helps that the eICU suite is in the same office as the infection prevention program.

“We are becoming interfaced with the staff,” says Hawkins. “We have the potential to come into those care rounds on a very active basis that’s essentially being done at the campus, so we have a two-way involvement there.”

You’re on candid camera

If this sounds a bit too “big brother” for you, you’re not alone. ICU staff members were initially resistant to the idea of someone watching over their shoulder from a well-placed camera, Kestner says.

“If you think of these people doing their work and all of a sudden they have a two-way video camera in the room and they know at any point in time someone could turn the camera on and be looking over their shoulders, they found that to very intrusive,” Kestner says.

The clinical practice committee that oversees the eICU, made up of five medical executive committee members, hospital presidents, and vice presidents, created a set of rules to alleviate the big brother feeling, including:

  • A bell rings to alert the on-site employee when the camera has been turned on
  • Twice per day, the on-site nurse and the eICU nurse conduct interdisciplinary care rounds with patients and their families, fostering a working relationship between the bedside and eICU staff members

These team rounds were particularly helpful to establish a working relationship between the eICU and bedside nurses and the patients.

“And so not only now do the nurses have a relationship with the eICU, but families and the patients know who is on the other end of the camera and establish a relationship with those care providers,” Kestner says. “It took us sort of actively intervening and teaching people how to act as a team in order to establish that relationship and not feel like the presence of eICU is intrusive, the presence of eICU is really being a part of their team.”

U.S. Department of Health and Human Services Secretary Kathleen Sebelius praised the system when she visited Alegent’s Lakeside Hospital on July 12 to experience this interaction first hand.

Ultimately, patients and families also feel more secure when they interact with the person on the other side of the camera and they don’t feel like it’s just a machine, Kestner says.

“We have patients that are transferred from some of our smaller facilities to our bigger facilities and the eICU will talk to the family before the patient leaves the smaller facility and then talk to them when they arrive at the new facility, so it makes them feel like their care has been seamless,” Kestner says. “Families like having that extra set of eyes and have a sense of comfort knowing that they are there.”

Absorbing the cost

Of course, as with any elaborate technology, the eICU comes with a hefty price tag. Alegent was able to integrate its rural hospital because of a United States Department of Agriculture Rural Development grant, Kestner says.

Some argue that having that extra set of eyes will decrease infections and lengths of stay and shorten patient days throughout the unit, ultimately benefiting hospitals’ financials. But Kestner says it’s also worth it from a patient satisfaction and efficiency perspective.

“I think the way we are looking at it is length of stay for the whole hospitalization, shortening length of stay in the whole ICU, shortening length of stay on the ventilator,” Kestner says. “We just have our baseline data, so I’m not sure we can say we have absolutely saved enough money to offset the initial expense, but it allows us going forward to remain efficient.”

As to whether this is sustainable technology for the future, Kestner recognizes that the startup costs are too high for most hospitals. He suggests this kind of movement in the future would require government involvement.

“You can almost suggest that it’s something similar to meaningful use,” Kestner says. “Is there a meaningful justification for this type of technology and does it improve outcomes and improve care and start to rationalize our work force issues? I think if the government was committed to that, they would have to prove that in order to fund it.”