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eICU: Tomorrow's Medical Care Today

Every critically ill patient is monitored every hour of every day.

A critical care nurse spots a warning change in a patient's condition. She immediately alerts the physician on duty and the necessary actions are taken to stabilize the situation.

It sounds like normal hospital Intensive Care Unit operating procedure. But, the critical care nurse was no where near the patient. She or he was miles away monitoring every facet of the patient's condition through eICU en Vision Technology, featuring round-the-clock, real-time audio and video monitoring of ICU patients. It was first brought on-line at Inova Alexandria Hospital in October.

"This is not a replacement for the bedside team. We see it as a working relationship with that team. Our goal to help the bedside team where ever we can," said Dr. Elizabeth R. Cowboy, medical director, eICU.

"It's like having an instantaneous critical care team at every bedside 24 hours a day. It increases the communications among the on-site team," she said.

THE $2 MILLION PLUS eICU is located on the second floor of the Verizon Building just off Route 50 in Falls Church. It has eight computer stations staffed by critical care nurses, each with no less than 17 years experience dealing with critically ill patients.

"We're not monitor technicians. We're nurses and physicians. Our role is kind of like that of a director. We each work here for one 12-hour shift per week, in addition to our normal nursing duties, each monitoring approximately 40 patients in two hospitals," said Susan Rogers, RN, of Inova Fairfax Hospital and part of the eICU team.

"We make our "rounds" electronically on a constant basis. The computer at each station has the patients divided into three categories. The most critical are designated by red dots, the next level by yellow dots, and the least critical by green dots. But, they are all critically ill patients or they wouldn't be in ICU," Rogers said.

"Depending on their level of need, each patient's critical data is checked either every hour, two hours or four hours. We are monitoring such things as blood pressure, heart rate, breathing, and even lab results. This constant monitoring enables us to spot a trend before it would be obvious to the bedside nurse. I can then alert her of that development," Rogers said.

In addition to these various monitoring capabilities, each eICU room is equipped with a camera which allows the eICU intensivist to interact with the patient. The cameras, located above the door of each patient's room, are "real time" meaning there are no recording capabilities. A green light comes on and a chime sounds when the camera is activated in a given room.

The camera does not watch staff or patients and can only be turned on when the eICU intensivist makes the request. However, they can be used to examine the condition of an existing patient and communicate with them as well as the bedside ICU team.

"The camera is so sophisticated, I can use it for something as delicate as assessing a patient's pupils. This is high-tech care that still connects us to our patients on a personal level. They smile, wave and talk to the camera, just like we we're right there in the room," Rogers said.

"Due to the critical shortage of nurses, some recent graduates are working in ICU and may need aid in performing certain procedures. Each of us in this eICU unit have years of experience and can supply that extra knowledge," she said.

There are eight eICU stations in the Inova Health System center each with its own multi-screen monitoring and camera capabilities. "Each station is dedicated to 25 patients. By the end of this year every Inova Health System ICU bed will be wired," Cowboy said.

"This building has a double generator backup so that we can withstand any weather condition or other problem without losing contact. We went into partnership with Verizon because of their technology. Our medical skills and their technological skills could enable us to go nationwide with this," she said.

"This is a private dedicated network. This enables us to keep all patient and hospital information secure. The key is to have encrypted data to protect patient confidentiality," said Stephen D. Martino, corporate account manager, Verizon.

This technology could be applicable to military use, such as with a MASH unit, or in aiding physicians and nurses dealing with disaster situations. "This can operate anywhere if you have the telemetry on both the sending and receiving ends. And it can be instantly operational," said Mohammad A. Rehman, network solutions engineer, Verizon.

"WE PRESENTLY have eICU capabilities at each of our main hospitals and we only assigned our best nurses to staff this center. Having this capability also helps us to recruit new nurses and retain many who might otherwise retire," said Beth Visioli, media relations specialist, Inove Health System.

"It has a three-fold benefit. It alleviates the shortage of critical care physicians nationwide due to the stressful nature of the practice. It improves nursing recruitment and retention by providing an extra set of eyes to help the bedside nurses. And, it greatly improves patient care and safety," Visioli said.

Inova Health System is the first medical care organization in the Greater Washington Region to provide this capability. In January 2004 a study in "Critical Care Magazine" found that "the eICU/intensivist model reduced hospital mortality for ICU patients by 25 percent and the average patient's stay in ICU by 17 percent." It also credited eICU with reducing major health complications in critically ill patients.

The eICU system, created by Baltimore based VISICU Inc., was founded by two Johns Hopkins Hospital physicians, Dr. Brian Rosenfeld and Dr. Michael Breslaw, according to Jennifer A. Diven, manager, Corporate Communications VISICU.

"They worked in critical care at Johns Hopkins and saw the need for improvement. There's a lot of burnout among critical care physicians," Diven said.

"It was developed in 1998. Our first customer was Sentara Healthcare in Norfolk in 2002. We are now in 28 healthcare system throughout the United States, including Alaska and Hawaii," she said.

"At our Honolulu site we are able to monitor patients as far away as Guam. This eliminates the need to airlift them to Hawaii to receive critical care expertise. We are planning on expanding into Korea in the near future," Diven said.

DURING THE OFFICIAL ribbon-cutting ceremony on Jan. 27 in the eICU center, Knox Singleton, CEO, Inove Health System, said, "This is something many people have worked on for a very long time. Inove Health System has an average of 8,800 patients in ICU in a given year. And, one of the main things this technology can do is reduce the mortality rate of those patients by 20 to 25 percent."

Gerald E. Connolly, chairman, Fairfax County Board of Supervisors, joining in the ceremony, said, "We are always looking at how we can advance our technology to better serve the citizens of Fairfax County."

According to Terry Davis, RN, Inove Health System's patient care director at the eICU, "We have trained over 500 nurses in the use of this technology so far. And, eventually all 1,000 intensive care nurses will be trained."

Cowboy assured the assembled crowd, "There is a very human quality to this technology. We are able to help nurses and physicians with every service. But, we can never replace the bedside care team."