Every time Gene Burke checks on a patient, he announces his arrival by speaking into a headset. His voice comes in over a microphone set up near the patient’s bed.
“Hello,” Burke says to one man, watching a video- transmitted picture of the patient’s room on his computer screen. “I’m just here looking in for a minute.”
The man has serious heart problems. Burke examines the amount of oxygen in blood going to his patient’s heart and the amount of fluid in his patient’s lungs. He looks at the latest heart rate, blood pressure and blood sugar readings.
“At the moment, his heart is doing well,” Burke says, turning off the video feed and getting ready to see another patient.
It’s just a routine check on a patient in intensive care, except for one major detail: Burke is 11 miles away from Sentara Norfolk General Hospital. He’s examining patients from inside a nondescript office building off Interstate 264.
The office is known as an electronic ICU, or EICU, a new concept in medicine that has made its nationwide debut in Hampton Roads. The remote surveillance system lets doctors monitor patients 24 hours a day via video cameras and computers, adding an extra set of eyes for staff working at the hospital. Twenty beds at Norfolk General are hooked into the center.
No Peninsula hospital is part of the system yet, but that will change soon. In mid-September, 16 intensive care beds at Sentara Hampton General Hospital are scheduled to come online, so EICU doctors in Norfolk also will monitor patients on this side of the water.
What exactly is this coming our way?
Supporters say it’s a way to catch small problems in the most critically ill patients before they turn into health crises. That’s especially important given a serious shortage of critical care nurses and doctors specializing in ICU care, called intensivists.
Skeptics worry that an EICU might strip power from on-site doctors and nurses and make hospital stays more impersonal and less private for patients. They also wonder if data transmitted to off-site doctors is perfectly accurate.
Here’s how the EICU works: From noon to 7 a.m., an intensivist mans the center with a nurse and a clerical assistant. Those are hours when intensivists tend not to be on duty at the hospital and nurses are stretched to look after more than one patient at a time.
At the EICU, doctors can see and hear patients and talk to hospital staff in real time. They can do virtual rounds, zooming in close enough to see patients’ chests rise and fall as they breathe. They can read medical charts and check vital signs, lab results and X-rays.
“What’s important is that we’re not here to replace any bedside physician,” said Gene Burke, an intensivist who works in the EICU. “We want to make sure their plan of care is followed in careful detail. If we can stop lots of little complications, we can keep big things from happening.”
A study of more than 200 patients at a Baltimore- area hospital found that 24-hour remote monitoring led to a 60 percent reduction in mortality and a 40 percent reduction in complications. Per-patient costs in the ICU fell from $9,450 to $7,284. Sentara believes the new service, which costs $800,000 to $1 million annually, will pay for itself in three years.
Still, not everyone is convinced. Nurses are adjusting to having cameras in patient rooms, which some feel is too intrusive. Some doctors worry they are losing control over patients and that administrators might use the system to replace doctors in the hospital, although Sentara leaders say that won’t happen.
One concern is the reliability and completeness of data fed into the EICU, said Barry Shapiro, interim chief executive office for the Society of Critical Care Medicine, a non-profit group working to improve ICU care across the country.
There’s no reason to believe that’s a problem, Shapiro said, but no one can be sure until the system has been in place longer.
But Shapiro stresses that the Society of Critical Care Medicine endorses the concept of an EICU. A major reason is that less than a third of ICUs have qualified intensivists immediately available at all times, Shapiro said.
“There needs to be as much coverage for these patients as possible, and outside of large medical centers it’s difficult to do that,” he said. “This is a way to extend the resources we have to the greatest number of patients.”
Some patient families who have experienced the local EICU can see the advantages. Nikki Ongtawco of Virginia Beach talked to an off-site doctor about her mother, who is in intensive care at Norfolk General. For her, the immediate response outweighed the fact that the doctor wasn’t physically there.
“You don’t have to page a physician and wait for him to call back,” said Ongtawco, who also is a nurse. “This doctor can flick a switch and he was looking at my mother. In critical care, you want that kind of attention right away.”
To Peninsula residents who worry it’s an example of administrators trying to save money by cutting back on patient care, EICU staffers argue that the technology isn’t subtracting anything – it’s adding a pair of eyes. Today, patients often go long stretches without seeing a doctor if their health status doesn’t change, Burke said, especially during overnight hours. Doctors will continue to come into the hospital as needed to help patients, he said.
After about a month online, staff at Norfolk General is still adjusting. Sarah Darwin, a nurse and director of one of the ICUs hooked into the electronic center, said some nurses remain uncomfortable about cameras being in the rooms.
The EICU sometimes makes for more work because nurses are changing medicines and drawing blood and other samples earlier than they might have before. The major advantage is that nurses can call a doctor whenever they have a question or see a problem, Darwin said.
“The way things used to work is, we’d put call into doctor and wait for him to call back,” she said. “Then, if the doctor was in his office or at home, he didn’t have a lot of info on that patient. He might not even have seen the patient that day.
“This system is much more immediate. ICU patients can go downhill really fast, so it’s reassuring for us – well, certainly for me – to know there’s an extra set of eyes.”
More questions
* What is an electronic ICU?
This is a remote center where doctors can monitor patients in several intensive care units, or ICUs, 24 hours a day. Doctors can see and talk to patients via video cameras and microphones. They also can call up a patient’s heart rate, blood pressure and other vital signs on their computers.
* What local hospitals are involved in the project?
Currently, just Sentara Hampton General and Sentara Norfolk General. Norfolk General has been hooked into the system for about a month. Intensive care beds at Hampton General should be online in mid-September.
* Who sets up the electronic ICU?
A privately financed company called IC-USA, which is based in Baltimore and run by two doctors who used to manage adult critical care at Johns Hopkins. Sentara Healthcare has a five-year, multi-million- dollar contract with IC-USA that allows for expansion of the system to other hospitals. Sentara and IC-USA would not release the exact amount of the contract.
* Who are the doctors there?
Sixteen doctors currently are in the rotation. All have privileges at Sentara. They come from Sentara Medical Group, IC-USA, Eastern Virginia Medical School and Naval Medical Center Portsmouth.
* What does this do to staffing at the hospital?
Nothing. Staff levels stay the same. The EICU is designed as an extra set of eyes for doctors and nurses working at the hospital. In hospitals, ICU patients often see their regular doctor only during morning rounds.
* How often do EICU doctors check on patients?
That depends on how critically ill the patient is. The most unstable patients are seen hourly or more often if nurses request it. The maximum time that would pass is about four hours, and nurses would monitor patients as usual at the hospital.
* What about patient privacy?
Audio and video feeds are part of a closed- circuit system with multiple layers of security. Doctors in the EICU often don’t bring up pictures of a patient unless they see a problem, and they announce themselves before doing so.
* What is an example of something a doctor could do remotely?
If a patient’s heart rate started climbing, the EICU doctor could monitor the changes and tell a nurse to prescribe a certain medicine to bring the rate down.
* Is this concept likely to catch on?
IC-USA thinks so. In addition to the Sentara contract, the company has a deal with Walter Reed Army Medical Center in Washington, D.C. and says it is in contract negotiations with other major hospitals across the country. Doctors believe it could be especially useful for rural hospitals with fewer resources.
Alison Freehling can be reached at 247-4789 or by e-mail at afreehling@dailypress.com
