Arizona Telemedicine May 2014 - Page 33

E very hospital intensive care unit has its moments of high drama, but this one was especially dramatic. An ICU nurse at North Colorado Medical Center in Greeley, Colorado, checked in on one of her patients, who was on a ventilator and whose vital signs all looked fine. But the nurse had a feeling something was wrong. She contacted the Banner doctor who also was monitoring the patient from more than 800 miles away. Banner’s eICU™ operations center, known as iCareTM, located in Mesa, Arizona, monitors Banner Health’s ICU patients in 20 Banner hospitals across five states. Twentyfour hours a day, seven days a week, physicians and nurses in iCare monitor patients in 430 ICU beds – not replacing the nurses and physicians at the patients’ bedsides, but backing them up. Together, the bedside nurse at Colorado Medical Center and the eICU doctor began assessing the patient. Stat lab tests and X-rays were ordered. Suddenly, the patient started to crash. The X-ray arrived, showing a tension pneumothorax – the lung was leaking air into the chest cavity, resulting in compression of vessels returning blood to the heart, which can be fatal if not treated immediately. A hands-on physician was needed, but there were two codes in the emergency department and three surgical cases in process. The only available physician was a family medicine resident, on his first day in the ICU. The eICU doctor talked the resident through the steps of relieving the pressure by inserting a large needle into the chest. The patient immediately began to breathe easier and his oxygen saturation moved out of the danger zone. When the surgeon finished her OR case, she came down and inserted a chest tube. “The patient’s vital signs returned to normal and he was discharged two days later,” says Deborah Dahl, Banner’s vice president for patient care innovation. She oversees Banner’s telemedicine operations. “This is an example of why I love coming to work in the morning,” Ms. Dahl says. “We not only have the opportunity to change the way health care is delivered, and at Banner Health, we are taking full advantage of that opportunity.” Beginning in February 2006, Banner was one of the early adopters of Philips eICU technology. Combining the eICU technology with Banner clinicians and standardized processes has made a difference in patients’ lives. “We have the opportunity to change the way health care is delivered.” Deborah Dahl, Banner Vice President Over the past two years, Banner’s ICU mortality rates have been among the lowest in the country, Ms. Dahl says. In 2012, ICU actual length of stay was 20,000 fewer days than predicted based on patient acuity, and total hospital days were reduced by 49,000. Costs avoided totaled more than $68 million. Each of Banner’s ICU rooms is equipped with a fixed, two-way audio-video system. The bedside monitor sends real-time, continuous vital signs to the Philips system, while the electronic medical record interface sends lab results, medication orders, and other pertinent information from the bedside to iCare. In Banner’s iCare control room, the team of physicians and RNs works 12-hour shifts. The eICU technology can recognize possible adverse trends and alert the iCare team member who is monitoring that patient. For example, if a patient’s heart rate goes up from 70 to 74 to 78, that’s within normal limits. “But the eICU system says ‘Hmmm. The heart rate is drifting up, the blood pressure is drifting down, there may be something going on here,” Ms. Dahl explains. The system does a rapid analysis and alerts the nurse or physician that there may be a problem. “We’re looking for anything that might be a potential problem, so we can intervene before it becomes a major problem,” says Mary Cartner, an iCare nurse. She can use her camera to get a close-up view of a patient and make an assessment. She also can assist the bedside nurse with routine things like verifying the name on the wristband and making sure it matches the information on a blood bag. She can look in-depth at a single patient’s information or scan information from a block of patients. Bhavish Shah, MD, a critical-care specialist who spends one week a month in iCare – the rest of the time he’s in his home state of New Hampshire – considers iCare state of the art. “In the hospital, I can follow 10 patients a day,” Dr. Shah says. “Here I can follow 400. In iCare, my role is to respond to requests for help from the bedside, look for adverse trends and intervene before those adverse trends become adverse outcomes and assure that every patient is receiving the evidence-based practices they need.” Banner Health has recently expanded its telemedicine capabilities to include noncritical inpatients at two of its hospitals, Banner Gateway Medical Center in Gilbert and Banner Ironwood Medical Center in Queen Creek. Banner also now provides in-home services for patients living in the northwest Phoenix area with multiple chronic conditions and a history of repeated hospitalizations. “Five percent of the population accounts for more than 50 percent of the health-care costs in the U.S.,” Ms. Dahl says. “No one has ever said, ‘I wish I could spend more time as a hospital patient.’ We’re working to improve our patients’ quality of life, while reducing hospital visits and lowering the cost of health care. Although it’s early in the program, we’re pleased with the results.” Telemedicine Sites 29