Patient and Staff Acceptance
Does the notion of real-time video surveillance coupled with real-time data feeds on vital signs, lab work, and medications present problems for patients or staff? Patients are “very accepting and feel it’s an extra sort of security” knowing that Advanced ICU intensivists are on the job, says Dr. Gorman: “One patient referred to us as a ‘guardian angel’ looking over them.
“The nursing staff has been extremely accepting because it reduces their stress about making a determination of whether to interrupt the attending doctor during his office hours or at night,” she continues. “We’re really a partner to the local medical staff. We all know that to reduce medical errors, the bedside caregiver needs to recognize the problem, be able to contact somebody, address the problem, and then see if that intervention is the right one for the problem described. With eICU, you just move past all of those points of failure to get the patient right to the doctor in a very timely manner.”
Janet Pestle, RN, MSN, director of the Cardiovascular Program at SSM Health Care’s St. Mary’s Hospital and Medical Center in Jefferson City, Mo., echoes Dr. Gorman’s assessment. Encountering the same intensivist drought as other hospitals outside of metropolitan areas, St. Mary’s also contracted with Advanced ICU.
“I’d have a fist fight if I ever wanted to take [the eICU] away from the nurses and staff on the night shift,” declares Pestle. “I think there is definitely some guilt associated with healthcare workers having to wake up a doctor who may have been working all day. They love being able to push a button and have a physician there.”
Dr. Bailey believes the eICU offers many advantages for Saint Clare’s six-member hospitalist group. Although hospitalists have a large presence in the ICU, “ … we shouldn’t expect them to be intensivists,” he insists. “Given that the typical hospitalist is very young, I was concerned about setting up hospitalists for failure by not giving them the resources to help them provide high quality care and to be successful.”
Partnering with Advanced ICU has also helped recruitment of younger hospitalists, he says, noting that hospitalists have chosen Saint Clare’s over other hospitals because of the eICU presence. “Our hospitalists get very concerned about being pulled in too many directions,” says Dr. Bailey. “Advanced ICU frees up our hospitalists, giving them a high degree of comfort and confidence that they can handle multiple cases at once.”
To ensure continuity between the ICU and the medical floor, all admissions are still handled by the hospitalists. The eCare Manager software used by Advanced ICU also provides another layer of attention to quality indicators, with built-in decision support and alerts.
Outsourcing Opens the Box
Dr. Bailey visited Advanced ICU’s command center and was impressed with the frequency with which the company’s intensivists were virtually “rounding” on Saint Clare’s patients. “It’s very exciting if you think about it,” he says. “Intensivists in Missouri can talk with a radiologist in Hawaii about a patient in Wisconsin. This is certainly improving our quality of care.”
“The eICU is really mind-blowing,” agrees Dr. Wachter. Once services are no longer located in the building, “there’s not much difference between 30 miles and 10,000 miles away, and this just opens up the box in some very interesting ways.” Service providers operating from different countries under different sets of laws and value systems, he notes in his New England Journal of Medicine article, can, however, “create opportunities for new kinds of mischief.”