Nursing Meets the Electronic Age in the e-ICU

June 11th, 2012


By , BSN, RN

When I graduated from nursing school I was the only new nurse in my class to go into the operating room for a career. The majority of my classmates were determined to become ICU or intensive care RNs. There were certainly plenty of openings and there still are.

ICU nurses work with critically ill patients recovering from medical conditions, surgical procedures, and traumatic injury in specialized units in the hospital setting. The generic term often used is critical care nurse.

An estimated six million people are admitted to ICU units each year in the United States. How a patient ends up in critical care may vary but most ICUs have characteristics in common. The patients are in an unstable or life-threatening situation and require close nursing supervision.

ICU nurses are highly skilled and assess and manage rapidly changing patient conditions. An ICU is loaded with high-tech equipment that continuously monitors body functions and deliver specialized treatments. It can be a high stress environment for both the caregivers, the clients, and their families.

The ICU Meets The Electronic Age

Now, most ICUs are already pretty hi-tech. But there are some hospitals out there that have taken this cutting edge, high acuity department to all new levels. Meet the e-ICU.

The e-ICU care model is an intensivist-led ICU trained care team located apart from the hospital. That’s right, many of the actual caregivers are not even in the building. Amazing right? But, it solves a lot of problems and in many ways makes a lot of sense.

To steal from the explanation of one company (Philips Healthcare) who builds such units, an e-ICU is like an air traffic control center providing remote or after-hours support to actual units. The physicians and nurses who work in the e-ICU partner with ICU clinicians at the hospital unit. These units are also known as tele-ICUs, because of their incorporation of telemedicine.

In a typical e-ICU situation specialty physicians and critical care nurses are networked to multiple ICU patients across a health system by voice, video, and data. The team monitors patients and can execute predefined protocols or intervene in emergencies when a patient’s regular doctor is not in the ICU.

To continue that air traffic control analogy again, the technology incorporates 2-way video and “cockpit-like sensors” that enable the e-ICU staff to communicate with the bedside team and thereby reduce the time between problem identification and intervention.

This sounds like a hundred different science fiction movies brought to life—and it really is. But as we know, science fiction frequently becomes science fact. Nurses and doctors can be a world away and taking care of you as if they were at the bedside.

This is a true boon for ICU staffing. Not only is there the well-publicized nursing shortage, particularly in critical care, but there is also a shortage of physician intensivists. With an e-ICU a single critical care team can monitor dozens of patients in multiple ICU locations. Also, if the ICU is in a small or rural area, it allows for high end care that might not otherwise be accessible.

The Results Are In And They Look Good

So far research and study results have shown that e-ICU units are providing exceptional care and actually improving patient outcomes. ICU mortality rates and length of hospital stays were actually reduced in hospitals that researchers from the University of Massachusetts Medical School monitored. The findings were reported in JAMA (Journal of the American Medical Association) in 2011.

The study involved 6,290 adult patients in three intensive care units: three surgical, three medical and one mixed cardiovascular, at an 834-bed academic medical center.

The research group reported results from both before and after implementation of the e-ICU system.

  • Hospital mortality rate during pre-intervention period – 13.6%
  • Hospital mortality rate during e-ICU intervention – 11.8%
  • ICU mortality rate for pre-intervention group – 10.7%
  • ICU mortality rate for e-ICU group – 8.6%
  • Length of hospital stay for pre-intervention group – 9.8 days
  • Length of ICU stay for pre-intervention group – 6.4 days
  • Length of ICU stay for tele-ICU group – 4.5 days
  • Best clinical practice adherence in the pre-intervention group – 85%
  • Best clinical practice adherence in the e-ICU group – 99%
  • Prevention of stress ulcers in pre-intervention group – 83%
  • Prevention of stress ulcers in e-ICU group – 96%

The researchers also found significant improvements in the e-ICU patients in the prevention of ventilator-associated pneumonia and other preventable complications.

The authors wrote, "In conclusion, an adult tele-ICU intervention at an academic medical center that had been previously well staffed with a dedicated intensivist model and had robust best practice programs in place before the intervention was associated with lower mortality and shorter lengths of stay. Only part of these associations could be attributed to following best practice guidelines and lower rates of preventable complications. This suggests that there are benefits of a tele-ICU intervention beyond what is provided by daytime bedside intensivist staffing and traditional approaches to quality improvement . . ."

E-ICU Nursing

You can’t come right out of school and be an e-ICU nurse. Hospitals which have implemented these systems require different amounts of experience but the minimum I have found seems to be three years of work in an ICU, at the bedside, before you will be considered for a position in the e-ICU.

Hospitals that have an e-ICU system have seen the jobs for e-ICU nurses become so popular that some have waiting lists of RNs who want to work there in the control centers. One hospital system reports that nursing retention has doubled in units with these advancements in health care. The future is definitely now, at least when it come to critical care.

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