Imagine hospital employees who could interact with multiple patients, diagnose and treat their illnesses, administer drugs, and even ensure medical staff is following infection control best practices 24 hours a day, seven days a week, all without getting out of their 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 staff an offsite location filled with two-way cameras linked to ICUs in three metropolitan hospitals and one rural hospital within 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 recently Alegent has 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. Doctors and nurses in the eICU can also alert bedside medical staff 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.
But from an infection control perspective, it also provides a window to monitor compliance and effectively implement infection prevention bundles in a unit that is notoriously battling infections.
In its first two years, the eICU at Alegent has focused primarily on patient care, but Emily Hawkins, RN, BSN, director of infection control at Alegent Health, says the centralized location of the eICU makes it a great opportunity to integrate infection prevention compliance as well.
Hawkins says there are plans to use the eICU to build antimicrobial reviews, which will forward information to the lab and pharmacy. In the future, an infectious disease physician will be present to intervene with antimicrobial counsel.
"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."
You’re on candid camera
If this sounds a bit too "big brother" for you, you’re not alone. Kestner says ICU staff members were initially resistant to the idea of someone watching over their shoulder from a well-placed camera.