By Leef Smith, Washington Post Staff Writer
January 30th, 2005
A large bank of flat-panel computer screens is laid out before Linda Shaw, her eyes constantly scanning a sea of electronic graphs and data for trends.
Hunkered inside this buttoned-down high-rise in Falls Church, Shaw and her colleagues look like stockbrokers tracking the day's trades.
But what they're monitoring is considerably more important than the Nasdaq.
It is life and death.
Here, doctors and critical-care nurses such as Shaw are employed to watch over the health and safety of patients occupying intensive-care beds at Inova Health System hospitals across Northern Virginia.
Dubbed the eICU® system, the $2 million to $3 million protective layer of medical oversight was launched this fall to enhance patient monitoring and help staff nurses with patient care. The key component is technology that links patients with specialists several miles away.
"We're acting as a second pair of critical-care eyes" said Elizabeth Raitz Cowboy, a physician who is the eICU medical director at Inova. The hospital system is the first in the Washington region to install the system. "It's an additional level of safety," Cowboy said.
The technology is a growing trend in the nation's hospitals, which are struggling to improve care in intensive-care units while coping with a severe shortage of intensive-care medical specialists. So far, it appears to be a success.
A study last year in the journal Critical Care Medicine found that the eICU staffing model, which is used in dozens of hospitals nationwide, reduced hospital mortality for ICU patients by 25 percent and reduced the average length of stays by 17 percent.
Here's how it works:
Each critical-care unit is outfitted with digital cameras, microphones and special software that links patients to a medical team in Verizon's mid-Atlantic headquarters near Inova Fairfax Hospital. Without leaving its office, the team conducts virtual rounds, monitoring patients' heart and respiratory rates, blood pressure and other vital signs. Using video and audio links, team members can see and talk to the patient, even zoom in tight enough to check pupils.
Thursday afternoon, Shaw's six computer screens were alive with the vital signs of four patients. It took her just moments to check the status of a heart-attack patient, one with gastrointestinal bleeding, another who suffered respiratory arrest and another with sepsis infection.
"If we don't like what we see on the monitors, we can video in to the room," Shaw said. Officials say each patient is given audio notification when the camera is being turned on, and vital signs and medical information are transmitted via a secured, wireless transfer provided by Verizon, not over the Internet.
The idea, Cowboy said, is to help spot trouble before alarms sound and emergency intervention is necessary.
"We don't tell the nurses [on the scene] what to do," Cowboy said. "We don't take critical care thinking away from them. We just enhance it."
Sometimes, that means simply alerting a nurse stationed at the hospital when a disoriented patient has gotten out of bed. Other times, it means helping a resident physician insert a tricky central line, which Cowboy has done courtesy of the video link.
That's not to say that everyone at Inova greeted the system with a strong embrace. Although officials said the feedback from patients and their families has been positive, some nurses were wary of being checked by video cameras.
Terry Davis, a registered nurse and patient-care director for Inova, said that transitions are always hard but that initial concerns from the staff have mostly abated.
"We're not thinking for them," Davis said. "We're thinking with them."
© 2005 The Washington Post Company