On the ninth floor of the Cincinnati Department of Veterans Affairs (VA) Medical Center, in one room, nearly 72 critically ill veterans from across Ohio are managed by a single intensive care physician and two critical care nurses.
Patients are monitored by one Cincinnati VA intensive care provider who completes rounds upon his or her arrival, and then assesses patients every two to six hours depending upon their condition. This team is available at the push of a button to assist bedside providers when dire health issues arise.
It may sound like an impossible task, but it’s a reality with cameras, monitors and microphones and fully integrated, monitoring computer systems, which used in conjunction, allow patients not only in Cincinnati but also from VA centers in Chillicothe, Dayton and Cleveland to get the quickest, best critical care possible.
It’s called the VISN 10 Tele-Intensive Care Unit Program and is truly the future of critical care medicine, says Director Ralph Panos, MD.
"The TeleICU Program in place at the Cincinnati VA provides 24-hour, seven-day remote monitoring using state-of-the-art technology, including smart alarm software that detects potentially dangerous trends in patients’ vital signs,” says the professor and associate clinical director in the division of pulmonary, critical care and sleep medicine at the University of Cincinnati and associate chief of staff for research at the Cincinnati VA. "We are able to provide extra care or a second opinion for staff in four hospitals across the state.”
The VISN 10 TeleICU Program was initiated by VISN 10 Director Jack Hetrick and Chief Medical Officer Sheila Gelman, MD, and began operation in January 2012. Panos says the goal is to provide intensivist experience and coverage in hospitals that currently do not have night coverage or any sort of intensivist service at all.
"There is actually a national shortage of physicians trained in critical care medicine,” he says. "As a solution, this program allows board-certified intensivists to see patient information from ICU bedside monitors, video connect to rooms and speak with the patient or their families face to face, delivering care to multiple patients across a broad geographic area all from one location.”
Panos adds that the cameras are high-resolution and provide TeleICU physicians and nurses with the ability to zoom in so that they are able to look at a patient’s pupils or read numbers on prescription bottles or IV bags.
Six attending physicians take turns staffing the TeleICU from 7 p.m. to 7 a.m. and do not leave the room, where there is access to a bathroom, kitchen and exercise equipment to help keep them alert and active throughout the night. They work in a team with two critical care trained nurses.
The TeleICU team receives calls and notes from bedside nurses and physicians, updating them on the patient load, and on other vital information about the patients they are monitoring.
"One may think that all this information could overwhelm the TeleICU team; however, this has not been the case at all, and we’ve had great success so far,” Panos says. "We’re actually looking at adding additional hospitals to our service.”
Michael Torok, nurse manager in the TeleICU, adds that because of the success, there is talk of expanding this service to other VA networks throughout the country. Advanced protocols for the management of pneumonia, hypoglycemia, stoke and respiratory failure are being instituted to provide this care to all critically ill veterans.
"There’s more vigilance with this system, with more care given to the patient,” Torok says. "Physicians and health caregivers can get distracted at the bedside, which can lead to something being overlooked. With this system, the attending is able to stay focused on the task at hand, and the caregiver at the bedside has access to immediate feedback from another trained professional.”
This system also interfaces with electronic medical records, allowing the hospital to track patient data and trends more effectively.
And for internal medicine residents like Bo Stapler, the system helps with training.
"It provides extra security in the decisions being made for a patient’s care,” he says. "It’s nice to have that backup and be able to immediately consult with someone who has more experience.”
In addition, for nurses who may get overwhelmed with rapid changes in a patient’s condition, the tele-connection can provide "another set of eyes,” says Phirin Lorth, a nurse practitioner at the VA.
"It’s very helpful when we need a hand,” she says. "With this system, a TeleICU provider can keep an eye on our patient if we get called away suddenly.”
Panos says it has truly fostered a collaborative work environment and has helped care providers from around the state form strong working relationships that are beneficial when providing care for these patients.
"Everyone is looking for the one ‘Silver Bullet’ fix in critical care,” says Panos. "But it doesn’t exist. It’s meticulous attention to all the little details that results in better outcomes. The TeleICU Program is enhancing the work we do by allowing constant interaction and connection—and the ability to look at those fine details from even from hundreds of miles away—to achieve the best patient care possible. It’s been an incredible experience to be part of this program.”