I am often asked what the benefits are to being part of, or receiving care from, a healthcare system. Here, Ken Dey, media manager for St. Luke’s Health System, reports on a great example of one such benefit – the advancements in quality of care that are yielding better outcomes, saving lives, and lowering healthcare costs, as exemplified by our implementation of an electronic intensive care unit.
eICU technology and staffing would not otherwise be available at freestanding community hospitals, especially those in the rural areas of Idaho, and our eICU is just one more example of how St. Luke’s Health System is Taking Care Forward. I am so proud of all the talented, caring, and innovative nurses, physicians, and all the other caregivers at St. Luke’s Health System who make this great care possible.
As an electronic registered nurse, or eRN, Josh Daniels may not be at a patient’s bedside, but thanks to cutting-edge technology, he is playing a critical role in the care of patients throughout Idaho.
Daniels is part of a team of eRNs and critical-care physicians who spend hours before a bank of monitors, interacting with critical-care staff members and monitoring patients at St. Luke’s Health System hospitals and other regional hospitals.
“It’s a challenge to approach nursing this way, and there’s definitely a bit of a learning curve,” Daniels said. “But I really enjoy it, and most families are very thankful to know that their loved ones have the extra level of care.”
The monitoring takes place from St. Luke’s electronic intensive care unit (eICU) on the campus of St. Luke’s Boise Medical Center.
St. Luke’s launched Idaho’s first eICU Program in January, and by this November, expects to be monitoring and assisting clinicians in critical-care units and emergency rooms at 14 hospitals in Idaho, as far north as Grangeville and as far east as Twin Falls.
The eICU provides critical-care support in hospitals that often have limited critical-care resources, and that support will now be available 24/7.
The eICU, however, isn’t just meant for hospitals without critical-care resources. The St. Luke’s eICU also monitors units at St. Luke’s larger, tertiary-care hospitals.
Alison Rehmeyer, operations manager for the eICU, said the team's work and technology are not meant to intrude on the care of nurses and physicians in the units, but to serve as a resource to help with further monitoring of patients. The nature of critical-care units is that nurses and other care providers can’t always be at the bedside of patients, and that’s where the eICU comes in.
Daniels likens it to a football game, where the coach is on the field in the thick of things, just as critical-care staff in the units would be. He views the eICU as comparable to the defensive coach, who sits in a box above the field.
“The defensive coach is watching and looking for trends, looking for patterns, and that is what we’re doing with the eICU,” Daniels said.
Daniels recalls one patient who was being monitored in the eICU when an eICU physician was alerted to a change in the patient’s heart rate that was concerning.
Because the eICU integrates with all the bedside monitors and has access to patient lab reports and records, the physician was able to determine that the patient was in distress.
“We were able to help get the appropriate resources to the patient quickly. They then proceeded to the operating room, where they determined a blood vessel had ruptured,” Daniels said.
Daniels says the eICU is the extra helping hand and extra set of eyes when needed. From the bank of computers that he monitors, he can see every aspect of what is going on with each patient. When it’s time to look into a room, there is a camera that incorporates the same level of technology used in military drones. The camera allows an almost 360-degree view of the room, and the camera can zoom in with such clarity that it can read the smallest type on an IV bag.
The eICU camera allows for high-definition images so, for example, nurses in the eICU can even read small type on things like IV bags.
“I could literally do a thread count on the sheets,” Daniels said. “It’s a pretty amazing camera.”
Although the technology in an eICU is important, it’s only one component of a successful program.
“Historically with other eICUs, communication has been the toughest challenge,” Rehmeyer said. “Interacting and communicating by camera can be awkward at first, especially for ICUs that don’t have foundational relationships with the eICU staff who are monitoring their patients.”
St. Luke’s, however, had an advantage, in that all but one of the nurses staffing the eICU came from within St. Luke’s and had already developed relationships with staff and physicians in the units they were asked to monitor.
Nurses who monitor patients in the eICU continue to work shifts in those units. In addition, Rehmeyer said critical-care nurses also spend time shadowing in the eICU, so they can see how it works from an eICU nurse’s perspective.
To gauge the success of the program, Rehmeyer said St. Luke’s will be looking at key measures, including decreased length of stay, mortality reduction, and ultimately, reduced costs.
As an example, Rehmeyer said having a physician in the eICU during the overnight hours allows staff to have immediate access to a critical-care physician. Having a physician resource readily accessible throughout the night allows bedside care providers to address non-life-threatening issues right away, rather than waiting until the next morning, when attending physicians would traditionally be available.
“Because there is a physician on at night, if the staff sees an issue such as a need to adjust medication or do an X-ray, they can consult with the eICU physician and decide what to do,” Rehmeyer said. The benefit of adjusting patient treatment and seeking additional tests at any time not only improves the quality of care, but ultimately helps reduce the amount of time a patient has to stay in a critical care unit, she adds.
The eICU program is still very early in its history, but Rehmeyer said preliminary data already shows a slight reduction in the length of stay for patients, and expects that measure to continue trending lower. Nationally, other health systems have seen a 22 percent reduction in mortality and a 23 percent reduction in length of stay in connection with use of an eICU.
“We know that studies have shown improved outcomes and decreased lengths of stay for patients in ICUs managed by physicians trained in critical care, but many smaller hospitals are unable to have critical-care physicians on-site 24 hours a day,” said Dr. Brian Goltry, director of St. Luke’s eICU program.
“This technology allows us to extend our critical-care expertise virtually to all St. Luke’s sites. We expect to see a reduction in mortality rates and reduction in the length of stay as we fully implement our eICU efforts.”
For Daniels, the benefits to patients are important, but he’s also finding that he’s enjoying the ability to optimize the care of the patients he monitors.
“It really is the wave of the future and it allows us to help in a unique environment,” he said. “I get to interact with a lot of different personalities, and virtually be everywhere in Idaho. I’m really grateful and thankful for chance to do this.”
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.