It’s the dark of night at a US hospital and while patients in the intensive care unit are vulnerable to taking a turn for the worse, in a mission control centre on the other side of the world, critical care staff are monitoring their vital signs and providing urgent medical care.
At Royal Perth Hospital in Western Australia it’s daylight and an intensivist and a critical care nurse are watching the screens tracking the conditions of patients in the ICU at Emory Healthcare in Atlanta, Georgia.
Harnessing the advantages of the time zone differences between the two countries and using advanced audio-visual technology and algorithms, the eICU allows Australian-based clinicians to continuously monitor multiple critically ill patients remotely, predict deteriorations in health, communicate with on-site ICU staff via live video link, and advise on the best courses of treatment.
Emory Healthcare and Philips have launched the new Remote Intensive Care Unit Monitoring Program based at RPH to augment the care provided to high risk patients, reduce the burden of traditional night shift work, and advance the globalisation of critical care through technology.
Katie Casey is an advanced practice provider at Emory’s Mercy Clinic in the US who has used the technology in her work. It also provided her with some comfort when her mother was hospitalised at the Emory Saint Joseph’s ICU.
“I was worried about leaving my mom, not because I didn’t trust the wonderful staff at the bedside, but because of all of the “what if” questions that were rampant in my head,” Casey told Healthcare IT News Australia.
“What if something happens while I’m gone? What if I’m not here and her oxygen drops? The eICU technology gave me some sense of comfort in knowing that someone, somewhere was watching my mom’s vital signs and bedside monitor. That extra set of eyes, in addition to her wonderful bedside care team, made me feel safe to go home and get rest overnight.”
As a nurse practitioner who works the night shift, Casey said she relies on the physician on the other side of the screens and monitors in the eICU to be a watchful eye, especially in cases with diagnoses that are seen less frequently, or in critical cases when a patient’s heart stops or they require immediate intervention to prevent catastrophe.
“I have a physician readily available to me to support and offer expertise to ensure that all patients, even those with rare diagnoses that I don’t have as much experience with, get excellent and comprehensive care. In emergency situations, like a cardiac arrest, when innumerable things are happening at once, the eICU is extremely helpful in being an extra set of eyes, an extra layer of support who can help take over and run the code if I have to change my focus to something like a procedure, such as an intubation.”
Following the success of a pilot program run out of Sydney in 2016, this partnership represents the future of globalised connected critical care, according to Director of the Critical Care Centre at Emory Healthcare and Perth-based eICU physician, Dr Tim Buchman. He said the benefits of the program are “too numerous to count” but the technology is proving its worth in some traditionally complex situations.
“Supporting patients as they are initially cared for in the emergency department and transitioned to the ICU – such transitions are often dangerous because of the communication that is required and the handoffs that must occur. My telepresence in both physical locations enables smoother transitions of care,” Buchman said.
“[Also] situations where multiple consultants need to reach a common position as to the best next step for a patient. Having the telepresence and the data often helps coordinate the discussion and resolution of ambiguities and uncertainties.”
Overnight is when adverse events are most likely to occur for ICU patients and, for Buchman, it’s at this time and when a patient deteriorates that the system shows its value.
“The ability to see the patient, speak to the providers and have all of the ancillary information in front of me – waveforms from the monitor, lab data, the electronic medical record – often enables me to see ‘what is there’ and ‘what is missing’. An example of what is missing is that an oxygen supply has become disconnected or a medicine has run out.”
Liz MacLeod, Chief Executive of Western Australia’s East Metropolitan Health Service, said hosting Emory Healthcare’s eICU at RPH will provide a front row seat to a program defying distance.
“We both share the same goals and objectives, which are to provide the best patient care possible. Hosting this program at RPH allows us to see first-hand how remote ICU monitoring could possibly change the face of acute medicine in the future, by bringing together geographically dispersed teams in different parts of the world.”
The Philips eICU program at Emory Healthcare was implemented four years ago and has chalked up some successes in patient outcomes and cost cutting.
Over 15 months across its 136 beds at five hospital sites, Emory discharged more patients to home healthcare (+4.9 per cent) than nursing homes or long-term care hospitals (-6.9 per cent), saved an estimated US$4.6 million over 15 months (a US$1,486 reduction in average US Medicare spending per patient), and decreased 60-day inpatient readmission (-2.1 per cent).
Philips CEO for ASEAN and the Pacific Caroline Clarke said this new eICU shows the power of technology in solving healthcare’s challenges.
“This partnership is enabling a crucial shift in the delivery of care and impacting clinical outcomes, seeing technology support clinicians to deliver more proactive and timely care to patients across the world,” Clarke said.
“We know that access to highly experienced intensivists and critical care nurses is an ongoing challenge for hospitals, both here in Australia and internationally. Virtual care solutions, such as the eICU program, can help to deliver much needed expertise to areas where this is lacking.”