The solution to staffing shortages in ICUs lies in using technology that is already available to hospitals.
“Remote monitoring will help leverage existing manpower,” says Dr. Rainey. One option is electronic ICUs—or eICUs, which allow an intensivist and ICU nurse to monitor and manage part or all of the patient population in their organization’s ICU(s) from off-site, if applicable. This remote monitoring supplements on-site hospital staff, but allows fewer specialists access to more patients.
“eICU with smart alerts, physiologic status boards, [and] color-coded assessments of response to protocolized care may help hospitalists and intensivists on-site manage increasingly busy and acute ICUs,” says Dr. Buchman. “The greatest impact will be to facilitate the transformation of data into information and to highlight factors that are of greatest immediate importance.”
In addition to maximizing medical staff, eICU systems can also leverage technical support. Craft writes, “… it is easy to foresee a day when a network of hospitals might centralize its critical care application servers and patient record servers in one location to reduce IT staff overhead, standardize clinical protocols, and automate corporation-wide quality control mechanisms.”
With an eICU system, cameras, monitors, and communication devices provide information on each patient, and can even provide treatment recommendations or guidelines.
“eICU systems are evolving now,” says Dr. Buchman. “They synthesize data streams and allow us to stratify information with respect to how important it is. We’ve [already] had a few components, such as bedside hemodynamic monitors. For each individual patient, a sophisticated system should be able to take data from multiple systems, integrate it, and provide a snapshot of how that patient is doing. Take that throughout the entire ICU and have a display that presents instant pictures of how the ICU is doing. [Have] inventories presented in parallel to providers so they can see where problems are.”
Dr. Buchman predicts that in the future ICU care providers will take on more duties as managers of care.
“ICU providers will go through an evolution like airline pilots did,” he says. “These days, airline transport pilots don’t spend a lot of time actually flying the plane. There are plenty of autopilots and subsystems that do that. The pilot now spends most of her time managing the system, and intervenes as necessary to bring everything into harmony. I think this same type of sophisticated presentation will evolve in the ICU to provide a safer environment that uses the available human resource most efficiently. It won’t save on manpower, but it will greatly increase patient safety.”
J. Christopher Farmer, MD, FCCM, Division of Pulmonary and Critical Care, Mayo Clinic College of Medicine, Rochester, Minn., agrees—especially as relates to disaster response.
“We need technology that doesn’t rely on human factors,” says Dr. Farmer. During a hospital’s disaster response, “we miss things because we don’t notice them. We need automation of systems that will push information to us as computerized analysis; systems that look at everything, including lab results, and postulate on that information. This would help in critical care and could be used in disaster settings as well.”
Dr. Farmer’s vision includes automatic monitoring. “Ideally, I’d like to see every patient have a patch that reads their heart rate, oxygen levels, etc.,” he says. “This 100% monitoring of every patient is applicable in disaster medicine because otherwise you need a person to manually hook up monitors and check vitals on each patient.”
The evolution of ICU technology must focus on bridging the gap between limited staff and growing patient population as well as the gap between adequate care and excellent care.