High-tech gadgets monitor patients in new eICU® May 28th, 2004 Jane Meyer Contributing Writer If you've ever been at the bedside of a loved one in a hospital intensive care unit, you know that just when something happens, it seems the doctor is never around. Although the ICU is the most heavily staffed area in a hospital, there are times when the intensive care specialist is busy elsewhere or just unavailable. Sometimes this is merely an inconvenience. But at other times, when it takes precious minutes to bring in the all-call doctor, it can be life threatening. Soon that will change at Swedish Medical Center. By fall, the hospital will begin using new technology that allows an intensive-care specialist, an "intensivist," to monitor patients around the clock. The difference is that the doctor will be located in a special electronic control center where he/she is able to remotely monitor numerous patients at the same time, thanks to a new system developed by Visicu Inc., of Baltimore, Md., called eICU®. The initial installation cost of $2.7 million will come from a contribution from Swedish Foundation. Swedish will be the first hospital in the Northwest to install eICU®; to date, it's operating in or being installed in 44 hospitals in 13 states. If it sounds high-tech, it is. The 42 ICU beds in Swedish will be outfitted with monitoring sensors, and special cameras will be mounted in each room, all networked to the control center by voice, video and data. Special software will evaluate patients' physiologic data for changes and trends. Next year, in the next phase, Swedish will add the system at its Providence and Ballard campuses. It's also conceivable that in the future Swedish could provide the eICU® monitoring to intensive care patients at other hospitals, according to Lane Savitch, chief operating officer at the Ballard campus, who oversees intensive care services at Swedish. "We can monitor patients anywhere in the world, essentially," he said. The system was designed so that a team made up of an intensivist physician, an ICU nurse and an assistant can monitor up to 200 patients at a time. An eICU® doctor can perform virtual rounds by switching between patients, without leaving the control center. It may be high-tech, but it's not a sci-fi scenario in which the doctor is replaced by a computer. In fact, eICU® won't affect bedside care or staffing levels at Swedish at all, according to Dr. Jim Vincent, medical director of eICU® at Swedish. "It's not a take-away, but an additional layer of care, an early-warning system," he said. "The monitoring picks up more subtle changes than might not be recognized by current care processes." With ICU patients, the sickest of the sick, complications can develop suddenly. The quicker the complications are detected or prevented, the greater the success at treating the patient. Savitch likens the system to a lifeguard who watches the beach looking for weak swimmers before they get into trouble. "If you can identify patients who are 'weak swimmers' at risk for an event, you save tremendous trauma on the patient and cost to the system, he said. Visicu cites a clinical study showing a more than 25 percent reduction in severity-adjusted mortality rates for patients in eICU®s in Sentara Healthcare, a six-hospital system in Norfolk, Va., that installed the system in 2000. "I'm not sure we'll see that dramatic a drop (in mortality rates)," said Vincent. But we do believe this is a huge step in enhancing patient safety and improving quality." He believes it will also save money -- but not because of a reduction in staffing. In fact, Swedish will likely hire more critical care physicians when the eICU® opens, to cover the round-the-clock monitoring. The savings will come with improved care for patients, which translates to shorter hospital stays, lower use of supplies lab tests, therapies and medications, and a decrease in nursing hours per patient. "We're doing this for the quality gained," said Vincent. "The highest quality care ends up being best for the patient and economically the best for the institution." That return on investment has been borne out among the hospital systems that have been using the eICU®. Sentara Healthcare documented a 27 percent reduction in mortality as well as a 17 percent reduction in ICU length of stay. The net result was a savings of $2,150 per patient or $3 million above program costs. "The best way to save money in health care is to provide quality," said Dr. Brian Rosenfeld, co-founder of Visicu. "People might think they pay more for quality -- but in health care, you pay for mistakes. Complications are costly, increasing the length of stay in the hospital, and increasing the cost of health care." Vincent acknowledges that there may be some initial resistance to eICU®. "Anything new in medicine is met with healthy skepticism. That's human nature," he said. "My goal is to be certain it's widely accepted by our medical staff and our nursing staff." Staff orientation on the system is under way, and training will begin when the equipment installation is complete. He cites reports from other hospitals that eICU® is a "huge enhancer" to nursing support. In most hospitals currently, if an ICU nurse detects a potential problem with a patient at 2 a.m., he or she has to decide if and when to call the on-call physician, who's likely asleep and has to come in to the ICU. In the eICU® scenario, the doctor is wide-awake and in the command center with all the information about the patient at hand. Staff and patient response to eICU® has been very positive in hospitals around the country that have been using it, said Rosenfeld. "Patients and their families understand that in traditional ICU you're monitored round-the-clock by nurses. But having an intensive care expert available to identify when patients are beginning to get out of bounds makes intuitive sense," he said. Physicians have embraced the system because by design it was set up to supplement and maintain the attending doctor's care plan. "It's not very threatening," said Rosenfeld. "But I will tell you the physicians who feel the mot threatened are the ones who I believe feel the least comfortable with their ability." Rosenfeld and Dr. Michael Breslow, both critical care specialists at Johns Hospital for decades, co-founded Visicu, a venture-backed company, in 1998. For three years clinicians and programmers developed the software and early-alert technology prior to opening the first operational eICU® system at Sentara Healthcare in July 2000. Vincent is pleased that Swedish is on the leading edge of what he sees as an important trend in medicine. "We're stepping up early," he said. "Nationwide the demand for ICU beds is rising quickly." The aging of the baby boomers is already putting a strain on the system, and shorter stays will allow eICU®s to treat more patients, he said. And with the current shortage of critical care physicians across the country, the proactive system enables technology to leverage limited resources. "I've always been intrigued by technology's impact on medicine. This is a situation where I'm convinced it's going to have a very positive impact on patient care," said Vincent. "This is a program and a hospital system that's being born as we speak."