Finding Value in Intensive Care, From Afar New York Times highlights VISICU July 27th, 1999 BALTIMORE -- Staff members in hospital intensive-care units sometimes joke that the best time to be a patient is during business hours. Otherwise, they say, doctors may be scarce. Whether that is true is unknown. But now a group of intensive care specialists from Johns Hopkins Hospital here is trying to make the question moot. The group has developed a remote surveillance system that is designed to allow specialists to monitor intensive care patients from long distance, 24 hours a day. They say a trial of the system in a Baltimore hospital cut mortality among intensive care patients by more than half, which has led a number of hospitals around the country to express interest in the system as a way to expand service to their sickest patients. The system, with video cameras and computers, will allow teams of doctors, nurses and technicians at a remote command center outside the hospital to observe up to 40 patients at a time and evaluate a continuous flow of data from the bedside, like heart rate and blood pressure. The teams will also have computerized access to each patient's medical history and the latest research on a broad number of medical conditions. In theory, they will be able to spot any sudden change and tell hospital workers what to do. The doctors designing the system, which is expected to be ready for use later this year, acknowledge that each command center would cost up to $4 million to set up. But they said that, in addition to its health benefits, the system would ultimately cut medical costs by earlier detection of problems, shorten stays in the intensive care unit and ease strains on doctors who work there. Its inventors, Dr. Michael Breslow and Dr. Brian Rosenfeld, said the pilot test reduced hospital costs by 25 percent and cut the average length of a patient's stay by 30 percent. "The idea is, you want to intervene before a complication arises," said Dr. Breslow. "A nurse can recognize something like chest pain or when a patient stops making urine, but only after it happens." The doctors contend that their remote system, which they call Continuous Expert Care Network, will standardize maximum care by enabling the team of monitors to notify hospital staff the moment data show a change, suggesting that a serious problem is looming. In the Baltimore hospital where the pilot study was conducted, Dr. Haya Rubin, a health services researcher who served as an independent evaluator of the pilot program, said while patients were monitored by the remote system, the mortality rate of the sickest of them was half what had been expected. Dr. Rubin called the results "pretty remarkable," a response repeated by other intensive care specialists, some of whom worry that their ranks, numbering about 5,500 doctors nationwide, are not growing while the demand for their services does. "If this works, it's a helpful supplement," said Dr. Tom Rainey, a former president of the Society of Critical Care Medicine, who is now director of the intensive care unit at Suburban Hospital in Bethesda, Md. "But there is some abuse potential if it is converted into a system that replaces physicians at the hospital." Or as Rod Hochman, chief medical officer of the Sentana Health System of Norfolk, Va., which has expressed interest in the system, said, "Doctors with patients in an intensive care unit do not want to lose control of their patients." Dr. Rosenfeld and Dr. Breslow insist that on-site workers will have final authority over recommendations from the monitoring team They said the standardized care their system encouraged was their strongest sales point. But it remains to be seen whether the system will be adopted elsewhere. "From our standpoint, the number-one concern is quality -- saving lives, improving health and doing it quickly," said Chris Stenzel, director of development for Kaiser Permanente, the managed care organization. "We're impressed with it," he said. But he added that he would not try the system without more evidence of success. "With any new approach, especially in life-and-death situations, you don't want to go in and start making changes without solid evidence," he said. "Physicians are trained to look at hard data. That could make a big difference for us." Copyright 1999 New York Times Company