As the patient on the cardiothoracic intensive care unit reached for the ventilator tube in his mouth, possibly to pull it out, a voice called out, "Put your arms down, please." The patient, who had come out of surgery a few hours earlier, took his hand away from his mouth and looked around. Although no one was in the room, the patient knew he wasn't just "hearing things" because he had been told before surgery that doctors and nurses off-site would be monitoring him.
A new patient monitoring system has come to the cardiothoracic ICU at Columbia Presbyterian Medical Center, one that promises even greater improvement in patient care. Called eICU"e" stands for electronicthe system uses a camera, speakers, and a computer system to let critical care nurses and doctors in another building monitor patients and communicate with them and staff in the ICU.
Donna Burchie, an ICU and eICU nurse at NewYork-Presbyterian Hospital, used the eICU video camera after the computer alerted her that the patient's heart rate was going up, a sign he might be in distress. When she clicked on the video feed and saw the patient about to touch the ventilator tube, it was her voice he heard asking him to stop.
NewYork-Presbyterian Hospital, the first major teaching hospital to use the eICU system, made by Visicu of Baltimore, Md., initially is installing it in several ICU and intermediate care floors.
"The system should help doctors and nurses catch and address negative trends in patients earlierwhich is vital in critical-care medicine," says Dr. Hal Wasserman, associate clinical professor of medicine at P&S and eICU medical director at CPMC. "Clinical deterioration caused by serious infection, internal bleeding or respiratory failure is often preceded by subtle alterations of blood pressure, heart rate, and oxygenation. When such basic indicators drift toward the abnormal, they may be signaling a dangerous new direction in a patient's clinical course."
Such enhanced observation of patients has been shown at other hospitals that tested the system to reduce complications, medical errors, mortality rates, length of stay and costs, Dr. Wasserman says. Research by Visicu's physician co-founders at Johns Hopkins University School of Medicine found that risk-adjusted hospital mortality for ICU patients fell by 30 percent and complications decreased by 40 percent. Dr. Wasserman plans to conduct a study to see if NYPH patients receive similar benefits.
The system will be fully operational at both NYPH locationsCPMC and NewYork Weill Cornell Medical Centercovering 96 beds, by June. Once the CPMC rollout is complete, installation at the Cornell campus will begin, says Jennifer Sullivan, eICU nurse manager. Eventually the system will be made available throughout the 30-hospital NewYork-Presbyterian Healthcare System.
The eICU is installed in an ordinary office in the Service Building, across the street from the ICUs in the Milstein Hospital Building. The eICU desks, with their five monitors, allow doctors and nurses to observe patients and to receive up-to-the-minute heart-rate and electrocardiogram data as well as medication, laboratory, and other clinical information.
Using the video camera and the accompanying speaker, an eICU nurse or doctor can ring a "doorbell" in the patient's room and talk to the patient and unit staff. People in the patient room can only hear, not see, the person in the eICU. If the hospital staff needs to see the eICU staff, they can talk via video conferencing at the nurses' station. The eICU desks also have hotline phones that ring at the nurses' station on the floor. The camera in the patient room enables an eICU nurse or doctor to zoom in to see monitors on equipment such as ventilators, intravenous pumps, or the color of a patient's legs to make sure their blood is circulating normally, Ms. Sullivan says.
The eICU always has a nurse monitoring the screens, 24 hours a day, seven days a week. A doctor works alongside the nurse on duty at night and all day on holidays and weekendsthe times when fewer doctors are in the ICU and intermediate units.
The new system could help address some of the problems caused by a shortage of ICU doctors and nurses at other hospitals. "Most smaller medical centers do not have the specialists and expertise we have," Dr. Wasserman says. "But we can use the eICU system to help other hospitalspotentially anywhere in the world."