Houston Healthcare first state medical system to add eICU

by GENE RECTOR

WARNER ROBINS - Houston Healthcare is wired ... not only internally but, since Dec. 15, connected to an agency in St. Louis, Mo., for continuous, real-time monitoring of intensive care patients at hospitals in Warner Robins and Perry.

Fourteen ICU beds at Houston Medical Center and four in Perry are digitally linked to Advanced ICU's data center in Missouri. Houston Healthcare is the first medical complex in Georgia to install the new, eICU technology.

The hardware includes interface engines and monitoring hubs that enable St. Louis-based eICU specialists - known as intensivists - and critical care nurses to continuously monitor the sickest local patients. An in-room camera system allows the team to conduct "rounds" at specified times. Through the lash up, the team has access to test results, medications and continuous input from bedside monitors for each patient and can sound an alarm when a patient's condition worsens.

In turn, Houston Healthcare physicians and nurses can consult with the Advanced ICU team at any time by pushing a red button in equipped rooms or by dialing "9" on the room telephone.

Skip Philips, Houston Healthcare's president and chief executive officer, said a number of factors led to the new venture.

"With our new Northwest Tower, we have more beds and more patients," he said, "so we were concerned that we continue providing the best possible care. It's part of our focus to be the best community hospital we can for the people we serve - to continuously be in the top ten percent in the country."

Philips said 24/7 monitoring by the St. Louis team will improve patient care and treatment since local, attending physicians can't be at a patient's bedside all the time. It will also supplement the intensive patient monitoring already conducted in local ICUs.

"The (St. Louis team) looks for small trends long before a critical event occurs," he stressed, "and they are specifically trained in this area, so a lot of times they can spot small, incremental changes."

About 50 to 58 critically ill patients per month are using eICU rooms at Houston Medical Center and 15 to 20 in Perry. The system has already had telling impact.

"We've had very critical patients who have benefitted from this system," Philips acknowledged.

With the growing shortage of doctors and nurses - and the specific scarcity of ICU specialists - eICU is an affordable step to maintaining treatment standards, the CEO believes.

The hardware costs were about $250,000, he said, and the fees to Advanced ICU are well short of the expense of adding four to six intensivist physicians to the local staff.

"I'd say the cost is significantly less than half of what that would have cost," he said.

None of the eICU costs are passed on to the patient. "It is an investment we are making to better support our physicians, nurses and patients," Philips added.

Melinda Hartley, Houston Healthcare's vice president for patient care services and the chief nursing officer, said feedback from the medical staff and from patients and their families has been positive.

"The system works in conjunction with our attending physicians," she said. "Our physicians remain in charge of patient care, but the staff has told us that it gives them an added comfort level. Physicians here are having more and more discussions (with the St. Louis team). It's developing into a very collegial atmosphere."

Philips said the system earns its keep often in the wee hours of the morning when a nurse is alerted to a change in a patient.

"Before calling one of our physicians, they can punch the red button," he said. "The (people in St. Louis) are available. The nurse is not interrupting them. That's what they do. Then, if the nurse has to call the local physician, they have better information to report."

Dr. Rodrigo Morales, a Houston County internal medicine and pulmonary specialist, concedes that he and his colleagues are still in the learning phase of how to best interact with the system.

"There were some discrepancies between our expectations and what they actually do," he said, "so we're still in the learning process."

But he already sees significant advantages to eICU. "When we're in our office or at home, we can't physically see the patient," he said. "We don't have real-time access to patient information. The eICU doctors can look at the patient. They can look at everything together - the x-rays, lab reports."

Local physicians make final treatment decisions, Morales stressed. "But you also have the advantage of intensivists to help make that decision," he pointed out. "So this is more like a partnership."

The new initiative should be comforting to patients and their families, the local doctor noted - particularly what happens during a critical episode early in the morning.

"If something happens, somebody will be watching," he said. "Somebody is looking at that patient. And if I have to come in, I'll have more information on what the patient really needs."

Aimee Sams, a critical care nurse at Houston Medical Center, said she has had nothing but good experiences with the new system.

"If something changes with a patient, I can have someone on the phone immediately," she stressed. "Everything is streamed into them. They see everything. It's better for the patient because there is no delay."

Sams said eICU staffers act as an extension to local caregivers.

"They give us more confidence and they're very aggressive," she said. "They've been great."

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