By NATALIE FIELEKE
February 7, 2006
Jefferson City News-Tribun
 |
| A wall-mounted camera at St. Marys Health Center keeps track of the patient's situation for the physician handling the case. (News Tribune photo) |
Patients in St. Marys Health Center intensive care unit (ICU) in Jefferson City are now being watched over by medical staff both at their bedsides and from afar. In one case, the eICU ¨ system, composed of in-room cameras, intercoms and remote computer monitoring, kept St. Marys nurses from having to physically restrain a confused elderly person. In another instance, a wife was able to talk to an eICU doctor in the middle of the night about her husband's condition to get a clear determination of whether she should call family in from out-of-town.
These are just two instances Marilyn Russell, R.N., St. Marys ICU director, gave as examples for how the 24-hour, real-time patient monitoring is helping to fill a gap in care.
In January, St. Marys physicians and nurses began working with St. Louis-based Advanced ICU Care, a newly operating company employing nine physicians and 12 nurses specializing in critical care. St. Marys was the first hospital to begin working with Advanced ICU Care, but across the nation, there are 25 companies that provide 24-hour ICU monitoring using similar technology.
This service comes partially in response to a shortage of intensivist physicians, those board-certified and experienced in caring for critically ill patients.
Although St. Marys has been trying to recruit a full-time ICU doctor, hospitals in Central Missouri aren't typically able to have full-time doctors in the ICU, said Betsy Aderholdt, St. Marys president.
And Mid-Missouri isn't the only area having trouble augmenting ICU care. Less than 20 percent of ICUs across the country are staffed by intensivist physicians. Hospitals in rural areas are at a disadvantage since intensivists tend to concentrate in metropolitan areas.
"This is our way to use technology in the face of a physician shortage in that specialty, to bring that kind of coverage here," Aderholdt said.
How it works
A doctor's plan of care, or his recommended treatment for each patient, is intended to last about 12 hours. But ICU patients' condition can change quickly, and when attending doctors are in surgery or with another patient, nurses aren't always able to contact them immediately.
That's where the newly installed in-room cameras, intercoms and advanced computer monitoring intervene. In addition to being checked by a St. Marys physician once or twice a day, specialized equipment allows St. Louis intensivist doctors to constantly monitor patients' vital signs, and update patients' plans of care during about four "rounds" each day. If they're in serious condition, a doctor at the remote site is able to evaluate them every hour.
Dr. Dellice Dickhaus, medical director of Advanced ICU Care, attends patients by looking at their information on a screen in a concise and understandable format.
"Actually it's much the same in a lot of ways," she said, noting that physicians frequently rely on innovations in technology.
"The doctors at the bedside have the relationship and they create the plan of care," she said. "We have the flexibility to be in and out of the room that the bedside physician doesn't have."
When nurses detect a problem with a patient, St. Louis physicians with access to all of a patient's pertinent records are able to intervene immediately, updating a patient's plan of care with their St. Marys physician.
Remote computer monitoring provides an added element to patient care with its "smart alerts" system, explained David Schopp, president of Advanced ICU Care.
"Essentially we have the same information a physician or a nurse would have if they were in the hospital, plus we get some additional information, pre-established perimeters specific to a patients condition," Schopp said. "If it detects they're trending outside of where they're supposed to be it (the computer) alerts the doctors and nurses."
Aderholdt talked of how the "smart alerts" system could potentially benefit patients.
"What's so different is that, without this technology, we might not have picked out that trend as quickly," she said. "Lots of times, by virtue of the cumbersome system we work with, the nurse wouldn't call the doctor until the patient was really in trouble. At that point, we've lost a lot of ground. Through that computer assistance we'll know to begin to intervene much earlier ... It makes a nurses practice more fulfilling, but mostly, it makes for safer patient care."
Patient privacy
And patients won't have to sacrifice personal privacy for more responsive care.
Patients' vital signs are constantly monitored by computer and only viewed occasionally by camera.
Cameras are activated only when the clinician activates it in order to talk to the caregiver or the patient.
An emergency button in each of the 10 eICU-equipped rooms notifies staff in St. Louis immediately, Schopp said.
Schopp said other organizations that have studied patients perceptions of eICU technology and found that, on average, a camera was only on less than 10 minutes in a 24-hour period.
Russell said no patients or their families have reacted negatively to the idea of being constantly monitored.
"We give everyone who comes in the room a brochure, and the reactions we've had are 'Ooh, wow, this is cool,'" Russell said. "They're really happy with it."
Schopp cited an article in "Critical Care Medicine" from 2004, which says the technology reduces complications, length of stay and patient deaths.
"The perspective of the patient tends to be there's just another level of care, the doctor watching over me," he said.