Sutter eICU® Solution Saves Lives March 11th, 2003 In the high-tech world of Sutter General Hospital's intensive care unit, with its beeping monitors and blinking machines, the video cameras trained on patients and care givers are hardly a distraction. But these cameras represent much more than routine technology in helping to care for the hospital's sickest patients. They're part of a multimillion-dollar monitoring system that will expand to all Sutter hospitals in the Sacramento region in the coming year. The system functions as an electronic intensive care unit. Each patient in Sutter General's two dozen intensive-care beds is monitored at regular intervals day and night by an off-site team of specialists. The Sutter hospitals are the first in the western United States to implement the new system, developed by Visicu Inc., a Baltimore-based company started by two doctors at Johns Hopkins School of Medicine. In its first application, in hospitals run by Sentara Healthcare in Virginia, officials reported significant drops in mortality rates and shorter ICU patient stays during the program's first year. Sutter bought the system as part of a $50 million investment in new technology for all of its hospitals, in part because of the difficulty in recruiting critical care physicians -- known as intensivists -- to Sacramento. About 4,000 intensivists are licensed to practice in the United States, too few to staff the nation's 7,500 ICUs. Tucked away in a secure building in an undisclosed midtown location, Sutter's so-called eICU® features several work stations, each with four video monitors and a telephone with a direct line to the hospital ICU. One screen allows the nurse or doctor to view the ICU patient and his or her interaction with the nurse. A second screen offers a real-time view of the vital sign monitor, including constant heart rate and blood pressure readings. The third screen gives a full accounting the patient's medical record, including drug treatments and laboratory results. The fourth alerts the nurse or doctor to potentially dangerous trends in the patient's condition developing over several hours. The system is not intended to substitute for live bodies at the bedside, but functions as an additional layer of care. "Think of this as an air traffic control system," said Dr. John Mesic, chief medical officer and vice president of clinical integration for Sutter Health's Sacramento Sierra Region. "The pilot is the personal physician in charge. But we can track their progress. It's a safety net." The off-site team can monitor for medical errors and ultimately decrease mortality rates in the unit, said Dr. Daniel Ikeda, a pulmonary specialist and the eICU®'s medical director. In the first month the system's been online, eICU® staff have already caught one potentially deadly septic infection in a man recovering from surgery to remove his colon. While working in the eICU® late one evening, Ikeda noted on his computer monitor the patient's dramatic drop in blood pressure, contacted the man's doctors and authorized the unit nurses to give the patient stronger antibiotics and blood pressure medication. "I believe the early detection really headed off a serious decompensation in this patient's status," said Dr. Michael Aguilar, the surgeon who operated on the man. "Instead of being well behind the eight ball, which may be the case when you are notified in the morning, the changes were detected early on." After a second, emergency surgery to remove an abdominal abscess, the man recovered, said Aguilar. "No matter how good we were before the system, we will be so much better (now)," Ikeda said. "The patients will reap the benefits." Suzanne Delbanco, executive director of the Leapfrog Group, a nationwide consortium of major businesses working to improve health care, said mortality rates improve significantly when you have a specialist overseeing ICU care. She cited a study published in the Journal of the American Medical Association in 2000 which found that a patient's odds of dying in the ICU are reduced 29 percent when they have an intensivist managing their care. "We believe the eICU® is a very good alternative to having intensivists in the ICU," she said. "It can be brought into all ICUs eventually." Clark Miller, senior communications manager for Pacific Group of Health, a coalition of employer purchasers of health care, added that even if there were more intensivists available, many hospitals would not be able to afford them on a 24-hour basis. "Sutter is setting an example for other hospital systems in maximizing the value of these highly specialized people," Miller said. In most ICUs, doctors visit only when making their daily rounds on their own patients. In emergencies, nurses must track down a patient's doctor. "Instead of waking up a sleeping, cranky doctor, you instead have access to an alert doctor who has instant access to all the same patient information we do," said Dana Adrian, a critical care nurse who also works in Sutter's eICU®. While doctors said the system will take some getting used to, patients and their families have given it a thumbs up. Sabrina Ritchie of Sacramento was in Sutter General's ICU Friday recovering from hip replacement surgery. With additional problems related to her diabetes and osteoporosis, she said she liked the additional attention from the camera. "I feel like I'm being monitored, being better watched," said the 36-year-old. "Especially with all my health problems." Related Links View KCRA - 3 Sacramento's news coverage of the eICU® at Sutter General Hospital