Imagine you could interact with multiple patients, diagnose and treat their illnesses, administer drugs, and even ensure that staff members are following infection control best practices 24 hours per day, seven days per week, all without getting out of your chair.
This is the basic premise of the eICU, an electronic subdivision of the ICU at Alegent Health in Omaha, NE. Mark Kestner, MD, senior vice president and chief medical officer at Alegent Health, likens it to an air traffic control tower. Nurses and physicians man an off-site location filled with two-way cameras linked to ICUs in three metropolitan hospitals and one rural hospital in the system.
Six nurses in the eICU routinely manage 15–20 patients each, in conjunction with on-site ICU staff members. A physician handles high-risk patients, and Alegent recently added a pharmacist to monitor antimicrobial activity.
The software built into the eICU not only feeds real-time data for roughly 100 patients, including vital signs, laboratory tests, cultures, and pharmacy data; it also sorts the information and sets off alerts if there are concerns with a patient. Nurses and physicians in the eICU can also alert bedside staff members if a patient needs emergency care.
"What it does is it frees up the bedside staff because they know that certain elements of information are being sorted and addressed and that they can then be more available for the immediate needs of the patients or the routine bedside needs of the patient," Kestner says.
Involving infection control
In its first two years, the eICU at Alegent has focused primarily on patient care, but Emily Hawkins, RN, BSN, director of IC at Alegent Health, says the centralized location of the eICU makes it a great opportunity to integrate infection prevention compliance, as well.
A pharmacist has already been incorporated into the eICU to monitor drug interaction, but Hawkins says there are also plans to use the eICU to build antimicrobial reviews, which will forward information to the lab and pharmacy. Going forward, an infectious disease physician will be present to intervene with antimicrobial counsel.
The eICU team is already incorporating ventilator and central line bundles into its everyday care.
"I think what this allows us to do is to standardize our compliance with ventilator bundles and with standards of care," Kestner says. "We already had a very low infection rate, but this allows us to have another set of eyes on the team asking very specific questions every day. The eICU team does have the checklists and they make sure the central line is taken out if it's not needed, the ventilator bundles are adhered to, the patient's head of the bed is up, and the patient is being extubated quickly if they don't need to be on the ventilator."
It also helps that the eICU suite is in the same office as the infection prevention program.
You're on candid camera
If this sounds a bit too Big Brother for you, you're not alone. ICU staff members were initially resistant to the idea of someone watching over their shoulder from a well-placed camera, Kestner says.
"If you think of these people doing their work and all of a sudden they have a two-way video camera in the room and they know at any point in time someone could turn the camera on and be looking over their shoulders, they found that to be very intrusive," Kestner says.