Critically ill patients at hospitals in Carolinas HealthCare System have more doctors and nurses watching over them albeit from miles away from a virtual command center in Mint Hill.
Banks of computer monitors, with two-way cameras and audio, connect intensive-care specialists in this simple office building with critically ill patients and medical providers in five of the systems hospitals.
Patients in intensive care units are already among the most closely watched in the hospital. But experts say this new, extra layer of monitoring can save lives, reduce complications, shorten ICU stays and cut costs.
It also can help hospitals cope with a national shortage of specially trained intensive-care doctors and nurses.
This is the third virtual ICU in the state. The others are in Greensboro and Raleigh.
Around the country, the virtual ICU also called tele-ICU or eICU is rapidly becoming more common.
Philips Healthcare, which equipped all the North Carolina sites, opened its first center more than 11 years ago in Norfolk. Since then, more than 400 U.S. hospitals have been linked to more than 40 virtual ICUs.
Studies of the concept have produced differing results regarding effectiveness and usefulness.
And not all hospitals are adopting the approach. For example, officials at UNC Health Care and Duke Medicine said they already have sophisticated hardware and software for monitoring ICU patients and have staffs large enough to provide top-flight care.
Dr. Clifford Deutschman, president of the Society of Critical Care Medicine, said he was initially skeptical, but has warmed to the idea since it was adopted at his hospital in Pennsylvania.
Its promising, its important, its designed to address a big problem, he said, and its certainly worthy of careful study and review.
Like air traffic control
Carolinas HealthCare officials compare the service to an air traffic control center for critical care units.
Doctors and nurses in the virtual ICU can observe patients in real time, check vital signs and speak with nurses and doctors at the bedside.
Nurses can push a button and, in seconds, get a board-certified critical care physician on camera from the command center, said Dr. Nehal Thakkar, medical director of virtual critical care for Carolinas HealthCare.
Its pretty much instantaneous. With the camera, I can look at the patient and have a conversation with the nurse.
By supporting smaller hospitals that may not have fully staffed ICUs, the command center staff can reduce the need for patients to be transferred to more sophisticated hospitals farther from home, said Dr. James McDeavitt, a senior vice president for Carolinas HealthCare.
With better oversight and coordination, patients wont stay in the ICU longer than necessary, he said. That could decrease the risk of complications, such as pneumonia, and cut costs.
The virtual ICU can also help ensure doctors and nurses follow recommended practices. Computers trigger automatic reminders that certain lifesaving therapies should be considered in cases where they may have been overlooked.
Not enough doctors
McDeavitt said studies show every critically ill patient should have an intensivist leading the care team. But there arent enough doctors to go around.
Carolinas HealthCare has 63 intensivists who work in only 11 of the systems hospitals, including 28 at Carolinas Medical Center, the largest.
By rotating them through the virtual ICU, the system can expand the reach of their expertise.
The virtual ICU may improve response time. A nurse can hit the Elert button and immediately talk with a doctor, rather than having to page a doctor or call one at home in the middle of the night.
Youre always dealing with an awake physician, said Colleen Hole, a nurse and vice president of critical care services for Carolinas HealthCare.
At least three nurses and one physician, all trained in critical care, will staff the Mint Hill center per shift. Nurses who work full time at the center will continue to work hospital shifts once a month. Thakkar, who works full time as a pulmonary and critical care intensivist at CMC-NorthEast in Concord, will rotate shifts with other hospital-based intensivists at the Mint Hill site.
That was a big thing for both the physicians and the nurses, he said. We all said we dont want to be away from the bedside permanently.
A positive report
A recent study in the Journal of the American Medical Association provided one of the most positive reports about tele-ICUs to date.
It followed almost 6,300 adult patients in seven ICUs at one large teaching hospital and measured a nearly 2 percent drop in mortality, fewer complications and a drop in the average hospital stay from 13.3 days to 9.8 days.
Such outcomes can improve the hospitals bottom line: Medicare and other payers limit the amount theyll pay for ICU stays, and the pressure to hold down the number of days a patient spends in an ICU bed is expected to grow.
Despite upfront costs of $12.3 million for the virtual ICU in Mint Hill, Carolinas HealthCare officials said they expect the service will save money in the long run by improving efficiency and quality.
A patient in distress
On a recent evening, Thakkar arrived early for his 7 p.m. to 7 a.m. shift.
A nurse at CMC-University had already pressed the button for help.
In Mint Hill, one of three nurses, seated at a bank of six computer screens, responded immediately and asked Thakkar for assistance.
Using the video camera, they spoke to the hospital-based nurse and zoomed in to observe the critically ill patient, a woman in her 60s, on a ventilator, but still in respiratory distress.
On the multiple monitors, Thakkar read real-time data. The patients blood pressure was low. Her heart rate was high. He could see she was dehydrated and agitated.
I could pull up lab data, chest X-rays, any progress notes from other providers. All of that was coming to me ... to have a very good picture of the patient.
Thakkar quickly ordered IV fluids and medications. And he spoke by phone with the hospitals intensivist, who was driving in from his home to the University City hospital.
They continued talking until Thakkar, watching by camera, saw the other doctor walk into the room. He took over the patients care already up-dated on everything Thakkar and the nurses had done.
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