Oscar Noreuil, a critical care nurse with Advanced ICU Care, appears on one of the monitors in the critical care unit at Phoebe Putney Memorial Hospital through the hospital’s tele-ICU system that went live earlier this month. The system is currently operating in 38 patient rooms at Phoebe. (Staff photo: Jennifer Parks)
ALBANY — The shortage of intensivist physicians can make it almost impossible to provide the 24/7 monitoring that patients require, resulting in downfalls in quality of care — creating an incentive to bring in something to fall back on.
Phoebe Putney Memorial Hospital recently partnered with Advanced ICU Care, the nation’s largest provider of tele-ICU services, as a way to augment patient safety and quality of care in the critical care, medical intensive care and surgical intensive care units of the hospital.
“Across the United States, there is a significant impact due to an aging population, with those 65 and older using the hospital three times as much, which puts a strain on ICUs,” said Dr. Mary Jo Gorman, CEO and founder of Advanced ICU Care. “Couple that with a shortage of physicians, and you need to have a creative solution to make sure patients have the care they need when they need it.
“Only one in five hospitals have 24/7 intensivist care.”
Officials say the Advanced ICU Care intensivist-led team operates from a centralized location in St. Louis that is electronically connected to Phoebe’s ICU patients, allowing Advanced ICU Care to continuously monitor a patient’s vital signs, medications, labs, trends in clinical status and outcomes of care.
The Advanced ICU Care data management tools aids in identifying problems before they become urgent, prompting immediate intervention when necessary.
“When a patient is in the ICU, and the patient is settled into their bed … prior to starting services with Phoebe we did technological advances to connect patients to the center,” Gorman said. “We are informed the patient is there, and we immediately begin reading vital signs.
“When they make a turn for the worst, we can immediately respond to that change in condition.”
There are currently 38 patient rooms at Phoebe with this technology, with another 12 rooms at Phoebe North expected to come on board in March. The equipment was paid for through the hospital’s Gifts from the Heart funds.
“The biggest benefit would be to the nurses and then to the intensivists,” said Ernest Shock, director of critical care management at Phoebe. “We went live on Sept. 17, and prior to that, (nurses) used to call them (the physicians) and wake them up at night. They don’t get those calls now unless Advanced ICU considers it an emergency and the doctor needs to come in.
“I equate them to an on-call physician. They always have someone they can call … (prior to the system coming online) what we didn’t have was a 24/7 presence of physicians.”
A two-way video camera in each critical care patient room enables face-to-face consultation between the bedside and the Advanced ICU Care teams. Cameras are turned away from the patient and microphones are turned off when not in use. The sound of a doorbell lets patients and family members know when the tele-intensivist or critical care nurse “enters” the room, similar to when a bedside physician or nurse enters the room.
When the doorbell sounds, the camera will move toward whoever is speaking on Phoebe’s end of the line. There is a phone as well as an emergency button the staff at Phoebe can access to call the system up. If Advanced ICU picks up on a problem first, they can call into the system on their own.
“(Advanced ICU) specialists in critical care and nurses connect with physicians and nurses at Phoebe. The communication using video conferencing is with staff, the patients themselves — if they are able — or the family,” Gorman said.
Patient advantages of the system can include faster weaning from ventilator support, better compliance with ventilator “bundles” and shorter length of stay as well as a reduced likelihood of ICU-related complications and mortality, officials say.
This results in a better financial outcomes for both hospitals as well as patients, but there are other benefits for both parties.
“The direct benefit to the patient would be, say in a stroke situation,” Gorman said. “Twenty years ago, there was not much that could be done. Today, if it can be identified very quickly, we can significantly reduce (the impact of) the stroke.
“Hospital staffs work very hard, sometimes in multiple communities. They benefit from the level of expertise (from the system) at all times. We have seen significant improvement in nurse retention and physician satisfaction.”
It could also potentially mean more accountability for hospital staff, Gorman said.
“Technology is an enabler, and what has been demonstrated to be successful is the timeliness for the patient,” she said. “ICU space utilization is hard because it is labor intensive. With our program, hospitals can clearly identify how they are serving patients. It drives for better care for patients and performance in the ICU.
“Beyond technology, how it is used is very beneficial.”
At the sites they are active in, Gorman said there has been a 40 percent improvement in mortality rate and a 50-60 percent reduction rate in cardiac arrests incidents.
Shock said it might be a year before there are solid enough figures to show how the system is improving outcomes, but that it has gotten good feedback so far.
“It helps the staff last longer. When they are on call constantly, they get little sleep. It takes a toll on people,” he said. “I’ve talked to several families myself, and they are pleased to know there is an extra eye to look on their loved ones. The physicians who have been on call say they have already been called less.
“So far, it’s been positive.”