The VISICU Vision
True transformation emerges in many ways. In the case of VISICU, which was founded in 1998 by two nationally recognized intensivists from Johns Hopkins Hospital, the passion driving their effort was based on direct ICU experience that lead to a realization that there had to be a better way to provide ICU care. Their eICU^® idea was radical and required systematic change. Yet the promise it held was true transformation—using technology to leverage the scarce supply of intensivists and using information technology tools to standardize the care process while enabling these physicians to provide proactive care. The impact would be substantial: reductions in clinical complications and mortality; improved patient outcomes; increases in patient throughput and financial savings gained by minimizing hospital costs.

The “Prevention Effect”
Numerous studies have demonstrated that with intensivist care, ICU patients experience reduced complications, leading to double-digit patient outcome improvements. In 2000, the Leapfrog Group, a patient safety initiative representing Fortune 500 companies, called for full-time intensivist staffing as a way to save upwards of 50,000 lives per year. Unfortunately, there is a severe shortage. Less than 6,000 intensivists are actively practicing in the U.S., leaving only 13% of ICU patients receiving dedicated intensivist care. With the aging population and its anticipated impact on ICU’s, we can expect even greater shortages in the future.

The VISICU eICU Care Approach
The eICU care model sets the stage for systematic changes in ICU care. An intensivist-led eICU-based care team located apart from the hospital, works in concert with onsite ICU clinicians. The eICU facility does not house patients or replace the hospital ICU. It operates like an air traffic control center staffed 24/7 with experienced specialty physicians and seasoned critical care nurses who are networked to multiple ICU patients across a health system by voice, video, and data. The eICU team executes predefined plans or intervenes in emergencies when a patient’s attending physician is not in the ICU. Proprietary technology used in the ICU improves physician workflow and enables clear communication between the ICU and eICU facility. The technology also provides “cockpit-like sensors” that enable the eICU team to carefully monitor and ultimately reduce the time between problem identification and intervention. Software tools include:

1. Software alerts to avoid adverse events: Care interventions occur earlier because monitored patient information is processed through the company’s Smart Alerts® proprietary software, which evaluates patient physiologic data for thresholds and trends. Alerts identify when a patient is straying “out of bounds” and enable the eICU physician to execute an intervention, often precluding an adverse event.

2. On-line decision support: Standards of care are maintained and often improved because clinicians have on-line access to the VISICU evidence-based care guidelines. A comprehensive and interactive on-line decision support tool called “The Source”, supports algorithm-driven interventions for diagnosis and treatment. Care recommendations are regularly updated using evidence-based medicine, society guidelines, and input from an international panel of experts.

3. Outcomes tracking: Clinical outcomes, resource utilization, and operational efficiency are tied to the Agency for Healthcare Research & Quality (AHRQ) recommendations and are regularly tracked with the VISICU Smart Report™ system. Patient queries can also be customized for research purposes.

4. Relational database for actionable patient knowledge: The sophisticated eCareManager^™ software ensures organized on-site care and a seamless care transition between ICU and eICU care providers. The applications are presented in a dashboard-style user interface for fast clinical analysis of a patient’s condition and a quick review of assigned tasks.

Installation and Clinical Study Results

1. 27% reduction in severity-adjusted hospital mortality for ICU patients
2. 17% reduction in ICU length of stay
3. Savings of $2,150 per patient or 3 million dollars above program costs