Reinventing the ICU

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Research suggests that physicians specially trained to address the complex nature of critical care patients - intensivists - provide the best patient care for this population. Patient safety organizations have called for full-time intensivist staffing in ICUs as a means of saving an estimated 50,000 lives per year.

But intensivists are in short supply; approximately 5,400 physicians across the country are certified in critical care, enough to provide dedicated intensivist care for only 13 percent of the nation's ICU patients. The problem is not going away. Current projections estimate that critical-care specialist hours will exceed supply by 22 percent by 2020, and 35 percent by 2030. Nurse vacancies in critical care stand at 20 percent and continue to grow.

The intensivist shortage is one reason why many hospitals employ an open staffing model in the critical-care environment with a cadre of clinicians including surgeons, family physicians and cardiologists orchestrating care in a somewhat fragmented fashion. This model, however, is far from ideal. It can be difficult for clinicians to access all of the data they need to make decisions about critical patients because physiologic data, lab results, medication information and imaging studies are housed in disparate systems. 

A number of hospitals across the country have employed new technology to bring together various ICU decision-making elements and create a virtual ICU that leverages the limited number of intensivists and critical-care nurses. These hospitals are realizing dramatic improvements in multiple parameters in their ICUs.

  • Sentara Norfolk General Hospital in Norfolk, Va., shortened the length of stay for intensive care patients by 17 percent and reduced ICU mortality rates by 25 percent. Per patient costs dropped $2,150 based on reduced patient expenses and increased ICU capacity.
  • Health First Inc. in Rock Ledge, Fla., has seen a 16 percent reduction in mortality risk. The average number of codes per month has nearly halved, and survival rates following a code have increased from 51 percent to 75 percent.
  • Borgess Medical Center in Kalamzoo, Mich., has decreased the amount of time spent searching for patient data by 75 percent.

These hospitals have implemented virtual ICU systems in conjunction with conventional patient monitoring systems like Philips Medical Systems IntelliVue, GE Healthcare's Unity and Spacelabs Ultraview patient monitoring systems to create improve ICU operations.

The virtual ICU at a glance

One option for the virtual ICU is VISICU Inc.'s eICU system, which serves as a centralized 24-hour ICU surveillance solution for several hospitals. "The eICU program entails a remote, off-site monitoring station for ICU patients staffed by critical-care nurses and intensivists," explains Ralph Koenker, MD, medical director of radiology for Novato Community Hospital in San Francisco. Location is a non-issue; current eICU centers serve hospitals as far as 180 miles away from a virtual control center.

The model replicates and centralizes conventional physiologic monitoring of ICU patients and adds access to other key clinical data like images. Critical-care nurses view blood pressure readings, EKG, oxygen saturation, central line monitoring and all other data available on a traditional bedside monitor. The difference is that the nurse is stationed offsite in an office building; a video camera enables the remote nurse to see into patient rooms. At the same time, on-site ICU nurses continue to enter patient data such as intravenous medication infusion.

The real benefit of the approach is that it allows a group of hospitals to leverage the expertise of a single intensivist, who staffs the eICU center along with critical-care nurses. "eICU serves as surrogate for a full-time intensivist," explains Jim Shaffer, MD, medical director of Health First VitalWatch in Rockledge, Fla.

"Intensivists on-site at the eICU center can make decisions more rapidly than in a conventional setting, where the critical-care nurse must call a physician at home," sums Koenker. What's more, the intensivist has access to an array of data not available to an on-call physician. At Novato's Bay Area eICU, this includes real-time data from Philips' bedside patient monitoring systems and medical images via Siemens Medical Solutions MagicWeb PACS.

"Critical care is a very data-driven process. Minor changes in parallel areas like respiration, temperature and lab results can alert a physician