| Virtual ICU By Elizabeth Cooney TELEGRAM & GAZETTE STAFF Monday, March 19, 2007 WORCESTER— This man is really sick, Dr. Craig Lilly murmured as he scanned the bank of six computer screens in front of him. |
"The goal is to work as a large team to make sure every patient gets the best care." -Dr. Craig Lilly |
 Dr. Craig Lilly monitors patients in six intensive care units on the University and Memorial campuses of the UMass Memorial Medical Center. (T&G Staff/TOM RETTIG) |
| He was pretty sure the ICU nurse was on top of the situation, infusing medications at just the right rate to stabilize him. “They’ve really been working on him,” he said. But to be sure, he wanted to see the patient. Dr. Lilly is an intensivist, which means he specializes in care of patients in the intensive care unit. This day he was sitting at a workstation in a bunker on the medical center’s Hahnemann Campus. So he put on a headset and clicked his way to the bedside. A video link brought the patient and nurse into view. Just a quick scan reassured Dr. Lilly that his nurse was on top of the situation, serious as it was. He closed the video link after no more than 15 seconds, citing the man’s privacy and the nurse’s need to work undistracted. “We try not to be intrusive to our colleagues, but we want to be helpful and mobilize sooner if we need to,” he said. “The goal is to work as a large team to make sure every patient gets the best care.” The intensivists working in the ICU also rotate through the eICU, he said. “All the people that we have working here all work at the bedside,” he said. “Sometimes I’m here, sometimes I’m on the other side of the camera.” The patients they care for have complicated problems or they wouldn’t be in ICUs, with multiple monitors and medications and devices to help them battle their diseases or trauma. Their medical records contain a full array of imaging studies, lab results, medical history, doctors’ and nurses’ notes, plus real-time data on oxygen saturation or sugar circulating in their blood. To help manage all that information, a team sits in the control room at Hahnemann, backing up decisions made at the bedside and picking up on alarms technology can deliver. It’s called the eICU. Right now an intensivist and a physician assistant or nurse practitioner monitor 104 patients in six intensive care units on the University and Memorial campuses, with plans to extend the service to other hospitals in the UMass Memorial system. HealthAlliance in Leominster, Marlborough Hospital and Wing Memorial in Palmer are next on the list. Remote monitoring began as a way to solve the problem of too few intensivists to go around. High-profile support for intensivists came from The Leapfrog Group, an organization funded by The Business Roundtable to advise employers about providing health-care coverage for 32 million employees. Leapfrog made intensivist staffing in ICUs one of its requirements for hospitals to become eligible to care for those workers. Even with that recommendation, there is still a shortage of intensivists, Leapgrog said. In 2000, only 10 percent of hospitals had intensivists. A survey reported by Leapfrog in February said that 26 percent of hospitals now meet that standard. Remote monitoring got a boost in the late 1990s when studies showed that hospital ICUs that had no on-site intensivists improved their performance when a remote management program was introduced. One of the first vendors to offer a technology solution for virtual ICUs was the company VisICU. Implementation of its system in four campuses of a hospital system in Virginia and the reduced mortality rates that followed paved the way for adoption in other hospitals. “The real benefit of this, whether you use VisICU or any other of the commonly available systems, is to solve the fundamental problem that there are only 5,500 intensivists in the United States,” said Dr. David A. Kaufman, chief of critical care medicine at St. Vincent Hospital. The St. Vincent ICU is staffed by intensivists who have used a monitoring system within the hospital for 10 years to track ICU patient data. While it is not a virtual ICU in another location, physicians have access to it from their offices or homes when they are not in the ICU. The UMass Memorial eICU is being used in a way that’s different from the early example in Virginia. There already are intensivists working in its ICUs at the University and Memorial campuses. “The system is more sensitive than what’s at the bedside,” Dr. Lilly said, because it tracks trends. Blood pressure might be normal at one moment, but if it’s been sliding for a while, that’s worrying. The same with a rising heart rate, he said. Sometimes heart rate and blood pressure fluctuate when a patient’s family visits or when the patient is turned over during care. Or it could mean a crisis. The purpose of monitoring is to check that there are no gaps between best practices and the care being given, he said. The care must be tailored to the individual patient. If someone in the eICU has a question, a message will go to the team with the patient. There have been 6,468 clinically significant interventions since July, he said. “We have the technology to take you through a life-threatening illness,” Dr. Lilly said. |