Mission Control
Remote monitoring centers enable nonstop supervision of multiple
ICU patients

By Glen Fest
May 21, 2004

A postoperative patient at Memorial Hermann Southwest Hospital in Houston may owe his life to bedside experts who were on duty that night — two miles away at the hospital’s corporate headquarters.

The 54-year-old man was being monitored in the intensive care unit for an arrhythmia problem that had developed after his neck surgery. As closely as ICU floor personnel watched him, a team of critical care physicians and nurses was observing him in more detail through a bank of “mission control”-type flat-panel computer systems that displayed vital signs and a live video feed.

When the man began developing ventricular tachycardia — a sudden doubling or tripling of the heart rate that cripples the adequate flow of blood — the off-site physician immediately ordered bedside nurses to administer drugs and oxygen through a constant two-way audio link. The 3 AM crisis ended within two minutes.

Without the immediate intervention, “that might have developed into a code,” which itself could have taken an extra five minutes to set up, said Lisa Weavind, MD, the medical director for Memorial Hermann’s new “eICU Advantage” team. “When these patients do get compromised, they deteriorate pretty rapidly.”

Last month, Memorial Hermann Healthcare System joined a short list of 15 hospital organizations nationwide to adopt the “virtual ICU” concept, which supplements critical care units with computerized monitoring equipment that allows for nonstop oversight of multiple ICU patients. Memorial Hermann’s eICU is connected to 28 ICU beds at two of its hospitals in Houston. Plans call for all 200 ICU beds across its 11-hospital system to be eICU-monitored.

Not only is the eICU considered as a lifesaver, but also a potential cost benefit for units that are stressed from the shortage of critical care nurses and intensivists.

“This is tremendously exciting because of its potential benefit to patients,” Hugh Gilmore, MD, vice president and chief quality officer for Memorial Hermann, said in a statement. “It has the established potential to significantly reduce mortality and ICU length of stay, and increase nursing satisfaction and retention.”

The equipment, made by a 6-year-old Baltimore company called VISICU, is installed at Walter Reed Army Medical Center in Washington, Swedish Medical Center in Seattle, and Sacramento, Calif.-based Sutter Health.

VISICU describes the eICU as a “mission control” operation, in which eICU team members sit like air traffic controllers in front of a bank of monitors. Besides watching for anomalies that require emergency intervention, the eICU team also follows predefined procedures ordered up by the patient’s tending physician.

The eICU team also makes decisions from online, evidence-based care guidelines that aid physicians and nurses in decision-making.

Janine Mazabob, RN, an eICU team member at Memorial Hermann, said the nurses trained to work with the eICU are excited to have a single resource for medication history, white blood cell count trends, and blood pressure for each patient. “It really is an additional tool for them,” Mazabob said.

Studies point to some dramatic results for facilities with eICUs. In a Critical Care Medicine article, the six-hospital Sentara Healthcare system in Norfolk, Va., reported a 27% reduction in mortality for ICU patients, a 17% decrease in ICU length of stay, and a savings of $2,150 per patient — or $3 million above program costs — since incorporating the eICU program in 2000.

Another supplemental article to the Critical Care Medicine study cautioned that the eICU program should not replace the remote intensivist model as the “ideal” above a bedside specialist, because it may introduce roadblocks to family communication and ICU teamwork.

“These barriers can perhaps be overcome by collaboration in the development of patient care protocols, the rotation of staff through the e-ICU, and communication with the family by on-site personnel,” wrote Carolyn Bekes, MD, of Cooper Health System and the Robert Wood Johnson Medical School in Camden, N.J.

In at least one case at Memorial Hermann, Mazabob said, a teenager’s mother was actually reassured of her son’s safety when they explained the vigilant monitoring available. Many of Memorial Hermann’s critical care nurses also are more comfortable working with the system.

Critical care nurses know that “ICUs are needing to put more junior nurses in there,” Mazabob said. “And now you know you’ve got a safety net.”

To comment on this story, send e-mail to editorsc@nurseweek.com.