Remote ICU Management One healthcare system uses virtual rounds to help solve the intensivist shortage November 30th, 2002 by Stacy May Like most healthcare facilities across the country, Sentara Healthcare, Norfolk, Va., has a shortage of intensivists--about 25 to cover the 130 to 140 beds in the intensive care units in its six-hospital system. To help out, an off-site intensivist and critical care nurse are remotely monitoring and managing 50 of the ICU beds at three Sentara hospitals. The hospitals are connected to an electronic ICU (eICU®) powered by eCareManager™ software, a technology developed by the co-founders of Baltimore-based VISICU--Brian Rosenfeld, M.D., executive vice president and chief medical officer, and Michael Breslow, M.D., executive vice president for clinical research and development. Both former intensivists at Johns Hopkins University School of Medicine, Baltimore, Rosenfeld and Breslow had decades of first-hand experience in ICUs and firmly believed that remote monitoring could improve the environment for patients as well as physicians. On average, ICUs account for 5 to 15 percent of total hospital beds but 25 to 35 percent of hospital costs. Remote monitoring "saves lives and money. It's like the Holy Grail of medicine," says Rosenfeld. Starting in April 2000 with one 10-bed unit, Sentara's Norfolk General became the first hospital to connect to the eICU®. VISICU and Sentara worked together to address skepticism about remote care, comfort levels, and reliability and security concerns. Together their efforts helped improve patient outcomes and reduce clinical complications, mortality rates and hospital costs. In 2001, this partnership received first-place honors for inpatient organizations with 500 or more beds in the Healthcare Innovations in Technology Systems (HITS) partnership awards presented at the Healthcare Informatics & e.MD Expo & Conference in Chicago. Stretching scarce resources Intensivists are a very precious commodity, says Rod Hochman, M.D., senior vice president and chief medical officer for Sentara Healthcare. "When we interviewed the ICU physicians, we found that a number of them were at a stage in their life where they were burning out. The intensity of care in hospitals has increased dramatically over the last decade, and a lot of specialists have abandoned the hospital to do outpatient work." But when they presented VISICU's remote monitoring concept to hospital specialists, staff and nurses, Sentara executives weren't quite sure of the response they'd receive. "They had to sell it internally," says Rosenfeld. "It's really a fundamental shift in the way you take care of patients. It's not easy, particularly in healthcare, to change behavior." Acceptance of the new system caused little trouble, however, since staff quickly recognized its benefits. The eICU® doesn't replace the hospital ICU staff. It offers an additional layer on top of the care that is already being given within the unit. Intensivists from the Sentara Medical Group, Norfolk's Eastern Virginia Medical School, and nearby Naval Medical Center Portsmouth (Va.), along with critical care nurses, are contracted to staff the eICU® and monitor Sentara beds from noon until 7 a.m. each day. This period corresponds to the hours when physicians typically are not at their patient's bedside. The night shift, in particular, benefits from the electronic assistance. High-resolution cameras, monitors and other two-way communication devices enable staff to electronically "walk" from bed to bed via the eICU®, says Hochman. A decision support system called "The Source" offers treatment guidelines. Blood pressure, arterial pressure, ventilator readings, and lab data are available via virtual private networks on T-1 lines. If a patient's lab work comes back at 1 a.m., for example, instead of a nurse having to call the patient's physician at home, the eICU® physician can make any necessary treatment adjustments throughout the night. Smart alarms monitor vital signs and detect slight changes in a patient's condition. If necessary, a red light flashes to indicate that immediate intervention may be necessary. Better care for less Since implementation of the eICU® at Norfolk General, mortality rates have decreased by 23 percent, ICU stays have shortened by 17 percent, and savings have been estimated at more than $2 million. In addition, use of the eICU® has helped administrators "understand more about the different styles of care and levels of care" by different physicians, says Hochman, and "has enabled us to have more protocols and standardization around what best practices are." People who work with IT agree that if the time between information and action is shortened, care gets better, says Hochman. Together, Sentara Healthcare and VISICU have found a way to access available information and put it to use immediately--even from afar.