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Former Banner Desert Medical Center employee Bill Rob sits in front of a typical eICU workstation. Banner Desert monitors 19 units in 10 of their facilities in Arizona and Colorado.

Using eICU, an electronic monitoring system based in Mesa, Ariz. that watches over patients, doctors and nurses in the local ICUs have a direct link to board certified intensive care specialists and critical care nurses at any time of the day or night.

“Our unit averages 22 years of critical care experience in our clinical operations room,” says Crystal Jenkins, Banner Health senior nurse manager at the Banner Desert Medical Center campus where the monitoring station is located. “Our RNs are required to have at least five years of critical care experience before they work in the eICU. Each nurse monitors around 35 patients through this system. We are in 19 different ICUs between Arizona and Colorado and we’re currently monitoring a total of 242 beds,” she says.

The eICU set up is similar to an emergency dispatch center. The nurses sit at a workstation consisting of three computers and six computer screens. A total of eight of those workstations make up the Arizona system. From that vantage point, they can scan a patient’s room, read the vital signs at the bedside, and zoom in close enough to read information on IV bags and even on the patient’s ID bracelet.

“We use VISICU software,” Jenkins says. “The software is a patient population management tool that allows us to monitor this many patients. We watch for trends, for changes in vital signs and the system alerts us to even subtle changes that might not be picked up at the bedside. We’ll get a subtle change in a heart rate – say it’s trending upward. We will go in and investigate why it’s going up. Is there a temperature? Bleeding? We have the time to investigate whereas, at the bedside, the nurse may not be alerted until the range is violated. We will see the trend prior to hitting the limit. We can look into it before it becomes a crisis.”

Staff at the monitoring site includes four to five nurses, two secretaries, and two physicians. One of the physicians on duty from 7 p.m. to 7 a.m. is an intensivist trained specifically in intensive care. “Beginning in January, we will also have an intensivist on duty from 11 a.m. to 7 p.m. that will provide 20 hours of intensive coverage for remote sites,” Jenkins says.

At the remote sites, a camera and an eLert button and phone make up the two-way contact. “It allows the nurses at the bedside to call us if they need help and we can remotely camera into the patient’s room,” Jenkins explains. “And, intermittently, we camera into a room to check patient status.”

Jenkins says that four of the sites – Banner Estrella, Banner Thunderbird, Banner Gateway and McKee Medical Center – allow for two-way video. “We can transmit our image so the patient can see us as we see them.”

Terri Tuttle, Director of ICU, Telemetry and Cardiac Cath Lab at McKee Medical Center
Photography by Warren Diggles

At McKee, the eICU is available in six of the 12 ICU rooms, says Terri Tuttle, director of ICU, telemetry and cardiac cath lab. “We are so excited about it. We just went live Nov. 3, 2009.”

The eICU rooms look like a regular patient room except for the red eICU button and the connecting phone. Tuttle demonstrates by calling the Center. The camera is activated and sweeps the room, stopping at a point that takes us in as a nurse from the Arizona location appears on the overhead screen. She tells us she can see the irises in our eyes. When the conversation is finished, her image disappears and the camera returns to its original position, pointing up into a corner.

“The cameras are not recording-capable and are not on all the time,” Tuttle says. “And they are very concerned with patient privacy, so they always announce before they camera into a room.”

Benefits to the system are many, Tuttle says. “We always have someone available on-site, but when you know that pushing a button or picking up a phone will get an intensivist immediately, that is very helpful. And if we’re really busy and need a patient watched, we can call and say, ‘Can you watch the one in room number such and such?’”

Maggi Basinger, Director of ICCU and the Western States Burn Center at North Colorado Medical Center
Photography by Warren Diggles

Maggi Basinger, director of ICCU and the Western States Burn Center at NCMC, has been in intensive care since 1978 and can easily vouch for the benefits of the eICU system. “The day-to-day help is important. For example, whenever you hang a blood bag, you have to have two people to verify the information and the remote nurse can be that second set of eyes. They have access to the visual and to our electronic records and can double check what occurs. Each day they round on all the charts and they keep an eye on quality criteria.”

The immediate access to an intensivist is extremely helpful, Basinger says. “In the early days, we wore out the physicians who worked in ICU. It became very difficult to recruit and retain them because of the long hours and the on-call demands. They were constantly being called in. The nice thing with this program is that we have our internists on for 12-hour shifts. Five work here on-site and they trade off on-call nights but they don’t get called in nearly as often. So they can get more sleep because we can access the eICU intensivist.”

The ICU at NCMC launched its eICU involvement in 2005 with 16 beds and, in April 2009, added 10 beds in the Burn Center. Not every room is equipped with eICU but, Basinger says, “We have portable eICU units that we can move anywhere we need them.” The equipment is the same but rather than being static in a room, it’s on a cart that can be moved from room to room.

Basinger says that another advantage to the new system is in the quality of care it can help bolster. “We provide a high quality of care but this adds a level above and beyond. One of our quality initiatives for 2010 is about sepsis. We’ve been collecting the data for some time and they’ll set up the criteria.” Sepsis is an overwhelming systemic response to an infection in the body.

The remote site will automatically run a sepsis screen on every patient and notify the nurse if there is even a partially positive sign. For someone with sepsis, a resuscitation binder has to be done within six hours. “Right now, our mortality rate is the lowest of any Banner facility, but this can help us be better and why would you not want to be better?” she asks.

Jenkins says, “I constantly get comments about how nice it is to push a button and get a physician who was already awake and had the medical records in front of him. In the middle of the night, the doctor can talk to you and then follow up.”

The system was created because of the lack of intensivists. “We have some sites, like Sterling, that don’t have intensivists. The best plan is to have an intensivist in each ICU, but the country is short by 8,000 intensivists so this was created to use technology to leverage scarce or limited resources.”

As to the need for technical support, Jenkins says, “This product is one of the most reliable. It’s only had a total of three scheduled down times in the four years it’s been up. And, remember, we are an added layer of support. The on-site staff is always there.”

The proof is in the numbers, she says. “We are improving patient outcomes and decreasing the length of stay; we get quarterly reports showing that. There’s also a safety factor and we can’t put a price tag on every fall we’ve prevented or when we’ve kept patients from pulling out IV lines.”

Tuttle says there was some skepticism in the beginning: “Are they watching me? Are they taking over?” But that was short-lived. “Everyone quickly realized that this adds a level of professionalism that helps us do our jobs better. And that’s what all of us want,” she concludes. +