Wednesday, March 2, 2011

Remote IT allows docs to care for ICU patients from a distance

Computerworld - When Leo DeFault had what should have been a fatal heart attack almost three years ago, it was an alert bystander who knew CPR that kept him alive. But once he was at a community hospital, it was a critical care physician -- who was 25 miles away -- who saved his life through a remote IT system.

The electronic intensive care unit, or eICU, where Dr. James Shaffer was located allowed him to remotely instruct and watch emergency room physicians as they put DeFault into a coma using therapeutic hypothermia to lower his brain's temperature to 91.4 degrees Fahrenheit to reduce damage from loss of oxygen.

"This isn't a guy who fell down and bumped his head. He was dead," Shaffer said. "We were able to teach the bedside staff how to do the procedure. It went off without a hitch. The beauty of it is that Leo did well."

After inducing the coma, Shaffer was able to then monitor his patient for 10 days through the eICU, which allowed him to watch DeFault through a high-definition, two-way robotic camera that could zoom in close enough to detect changes in the capillaries in DeFault's pupils. Special software monitored DeFault's vital signs, and preset alerts based on DeFault's medical history alerted Shaffer to even the smallest changes in white blood cell count, oxygen levels and heart arrhythmia.

Healthcare and tech convergence

As healthcare and technology converge, more and more doctors will be able to do what Shaffer did: remotely intervene to save patients' lives and monitor their conditions from a distance. It's an advance in telehealth technology that also helps patient families.

For DeFault's wife, Barbara, having a critical care team monitor her husband 24 hours a day gave her peace of mind. "I was able to leave and come home, and maybe not rest, but I knew someone was watching him all the time," she said in an interview. "It was like having a private nurse right there. I just couldn't believe they could do this."

Even as Shaffer and two critical care nurses were remotely monitoring DeFault, they were also in charge of 60 to 80 other patients in five ICU units across three hospitals in the Health First healthcare system, which is based in Rockledge, Fla.

"The robotic cameras allow us to see and hear and talk to patients. Really, there are no walls," Shaffer said.


The system also has five mobile eICU carts, like the one used in the emergency room that initially treated DeFault. In April, the hospital system will add a fourth hospital to its eICU system and one mobile device, for a total of 102 remotely monitored ICU beds and six mobile carts.

An intensivist monitors a patient
Dr. Sarah Neilly, an intensivist at Health First's HealthWatch eICU, monitors a patient. Physicians and other healthcare professionals trained in eICU procedures can effectively monitor up to 82 patients in multiple locations. (Image: Health First)

In a typical ICU, during night shifts physicians respond only to emergencies when paged by charge nurses. The nurses can do very little, for example, if a patient experiences an irregular heart rhythm that could harm his health.

"[The nurse] can't even put in a urinary catheter without an order," Shaffer said. "So rather than paging a physician, which can take up to 30 minutes, they push a button or pick up a phone, and if I've not already seen the irregular rhythm, I'm clued in within 15 seconds."

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