The Doctor Will See You Now

Vol. 21 •Issue 4 • Page 11
The Doctor Will See You Now

Electronic Intensive Care Units Improve Care, Cut Costs

ICU patients demand close attention. Even the slightest change in their condition could indicate an impending crisis.

Thanks to electronic ICU technology, respiratory therapists have more eyes than ever focused on these critical patients.

At the University of Massachusetts Memorial Medical Center in Worcester, a computer in a control center five miles away continuously assesses patient trends. At any sign of trouble, it will alert intensivists. With the help of widescreen monitors displaying real-time patient information, an intensivist can check the situation and even interact with caregivers at the bedside.

“It provides an extra layer of safety,” said Scott Leonard, MBA, RRT, chief administrative director of respiratory care at the 834-bed facility. “All of our ventilators are interfaced into the electronic ICU. The camera can actually focus in and read the drip settings on the IV pole.”

Since adopting this technology, staff members in the UMass Memorial Health Care System’s ICUs, which contain 102 beds, have seen a dramatic improvement in patient care, according to an abstract presented by Leonard and colleagues at the American Association for Respiratory Care Congress in December.

The system, the first in the state, initiated more than 6,600 interventions between July and December 2006. During that time, mortality decreased 14 percent. Glycemic control achieved a 13 percent improvement in patients’ glucose values. Ventilator-associated pneumonia (VAP) rates dropped from 5.1 to 1.2 per 1,000 patient days. (The national average is 8.75 per 1,000 days.)

At the same time, the health system recorded significant savings. Median ventilator days decreased 15 percent. Patient length-of-stay dropped 5 percent.

“If you take a 500-bed hospital and get a patient out a half day sooner, it is like adding 60 beds to the hospital,” Leonard said. “It saves millions of dollars each year.”

Key to Care

Sentara Healthcare adopted electronic ICU technology eight years ago, and it has helped alleviate the crunch felt by the nation’s intensivist shortage, said Sarah Darwin, MSN, RN, director of critical care at Sentara.

Intensivists in the system’s command center monitor patients from as far as 80 miles away. Along with critical care nurses, the physicians go on virtual rounds, based on the acuity of the patients, and review lab and medication data as well as vital signs.

Sentara, which operates 180 ICU beds in seven hospitals in Virginia and North Carolina, was the first telemedicine ICU in the U.S. More than 70 hospitals across the country have adopted the technology since 2000.

“It was a leap of faith and scary at the same time,” said Dave Grooms, BS, RRT, respiratory clinical program manager at Sentara. Initially, RTs were nervous about a camera at the bedside.

“I had to explain, ‘Don’t be scared of the system because it’s different,’” he said, noting significant improvements in mortality and VAP. “It’s a good thing now. We get an almost instantaneous response to any clinical situation.”

For example, five years ago, ICU patients would never have been extubated in the middle of the night. But in the electronic ICU, a physician is present 24 hours a day. This, along with the development of weaning protocols and vent bundles, has decreased Sentara’s median ventilator days per patient from three to two.

“It’s proactive. Our respiratory therapists know they have the resources needed,” Darwin said. “And over time, we’ve seen cost savings through health care quality to offset the cost of the program.”

Administrators at UMass Memorial Medical Center agree: Early weaning is one key to patient care and cost reduction, Leonard said. “If respiratory care staff can get them off the vent and out of the ICU sooner, they can get them out of the hospital sooner.”

Shawn Proctor, associate editor and Web editor, can be reached at [email protected].