The eICU: An Evolution in Intensive Care

BY KEELY SAVOIE
TECHNOLOGY HAS ITS REVOLUTIONS, LIKE HENRY FORD’S ASSEMBLY-line vision, and its evolutions, like the growth of the Internet from its original military purpose to a nearly ubiquitous resource for communication and information. The eICU, or what New York-Presbyterian Hospital calls the ReSCU — Remote Specialized Care Unit — is an evolution in medical technology that may one day be as ubiquitous in hospitals and clinics as the Internet is in homes and offices.
ReSCU is a new way of monitoring patients in the intensive care unit. A kind of medical “mission control,” ReSCU is made up of a room full of computers that receive and analyze continuously updated data about patients’ clinical status. The ReSCU is also equipped with an automated alert system, Smart Alerts, that warns the staff about changes in a patient’s vital signs. It’s not unlike the machines that already monitor patients and beep if anything changes. The difference with this system is that ReSCU doesn’t have to be in a patient’s room, or on the same floor, or even on the same continent. Using audio, video, and “hot phones” ReSCU allows ICU patients to be monitored from anywhere — an eICU in Hawaii is now being used to monitor a hospital 3,000 miles away in Guam.
In ReSCU, the staff can communicate directly with patients or with the doctors or nurses on the floor. “If an alert pops up, we can videoconference to the room to see what’s going on,” says Jennifer Sullivan, a nurse practitioner who is nurse manager of ReSCU. “We can check vital signs remotely and, if necessary, contact the physician on the floor.”
Although the scenario may seem like something from George Orwell’s book “1984,” depicting Big Brother’s invasion of privacy, ReSCU has built-in privacy features to
put both patients and nurses at ease. A virtual “doorbell” rings whenever the audio or video is turned on and identifiable patient data is automatically disposed of after the patient is discharged.
“We never peek at anyone, and we’ve had no patient complaints,” says Dr. Hal Wasserman, associate clinical professor of medicine at P&S and medical director of the ReSCU system.
ReSCU is not meant to spy on patients but to provide backup to the staff on the floor to ensure that no crisis compromises the care or monitoring of other patients in the unit. “It is an additional safety net for monitoring and for intervention when the ICU staff is not immediately available,” Dr. Wasserman says.
The eICU has been shown to tangibly improve patient care. A recent Johns Hopkins study found that patients monitored through an eICU had a 30 percent lower mortality rate and 40 percent fewer complications than those on floors without an eICU. Monitored patients also stayed in the hospital for shorter periods and incurred lower costs than others. VISICU, the eICU’s parent company, estimates that each monitored eICU patient saves on average $2,000 because of shortened stays and fewer complications.
New York-Presbyterian is the first hospital to use the technology and the only one in the tri-state area. The hospital has one eICU at Columbia University Medical Center and another at the Cornell campus. New York-Presbyterian is also the only hospital in the country that has used ReSCU to monitor step-down beds outside of the ICU. The hospital’s eICU is one of nine eICUs in the United States.
Dr. Wasserman is optimistic about the future of the eICU; he thinks it will only become more streamlined and better integrated as the platform, hardware, and software evolve. “The technology is here to stay,” he says.

ILLUSTRATIONS: KATHERINE STREETER

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