doug campbell md panel presentation nov 3 2010

8/8/2019 Doug Campbell MD Panel Presentation Nov 3 2010

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The eICU

What is it?

How does it work?

What is it not?

What are the advantages?

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The eICU: What is it?

Computerized monitoring system developed byVISICU, a subsidiary of Phillips Allows monitoring of individual ICU beds virtually anywhere

in the world from a central facility staffed by physiciansand nurses

Designed to ASSIST the bedside team

Features: Real time two way video communication

Camera, microphone, and video monitor screen in every room

Real time monitoring of lab data, medications, nursing flowsheets

Access to imaging studies

Near real time data and waveforms from each bedside monitor

Smart Alerts and advanced trending eCare Manager, an electronic medical record for ICU


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Why eICU?

Critical care consumes 1% of the GNPannually

ICUs with 24 hr physician coverage have

shown a reduction in mortality byapproximately 25%

To fully staff all the ICUs in the US, 30,000

intensivists would be needed. Presently

there are approximately 6,000.

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Why VISICU?

VISICU is in over 60 hospital systems withmonitoring ICUs in over 400 hospitals

nationwide

Overall mortality reduction: 25%

Overall LOS reduction: 30%

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How does it work?

Bedside Equipment

Camera in every monitored room

Video monitor Microphone eICU access (Panic) button

eCare Manager/The Source keyboard & monitor Mobile carts

Central monitoring station (COR) Staffing

Equipment

Limitations Levels of monitoring

Physician Interventions

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INTENSIVIEW Monitoring Area

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INTENSIVIEW Monitor of

Patients Room

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Staffing

Central monitoring station Staffed around the clock by experienced ICU nurses at

a ratio of 1 nurse per 30 monitored beds

Physician coverage from 7PM-7AM nights, weekends,holidays at a ratio of 1 physician per 100 monitoredbeds

Physician coverage around the clock on weekends andholidays

Hospital staff privileges

Each intensivist will be a member of the local hospitalstaff

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Equipment

Monitors - 6 eCare Manager (2)

Care plan, quick summary, lab, flow sheets, order &

note writing

Remote camera operation

Waveform monitor

Trending monitor

PACS System access for images

The Source

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Limitations

eICU cant touch the patient or do physicalexams

Procedures must be done by the physician at

bedside

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Levels of Monitoring

Two Categories picked by the local physician Both categories: In the absence of the bedside

physician, the eICU physician will handle lifethreatening emergencies including cardiac arrest,hypotension, shock, acute respiratory failure until aphysician is available at bedside

Category I When any other urgent situation arises, the patients

physician will be notified by the eICU physician.

Category II In the absence of a bedside physician, the eICU physician

may order additional tests, change ventilator orders, IVfluids, antibiotics, electrolyte solutions, sedatives,analgesics, etc.

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Physician Interventions

Arrhythmias

Ventilator changes/Oxygen therapy

Spontaneous breathing trials

Fluid and electrolyte replacement Confirmation of line & tube placement

Blood administration

Talk to patients and families Critical values

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eICU: What is it not?

It is not BIG BROTHER No video or audio is ever recorded

The eICU never monitors a bed without the knowledgeof the personnel in the room

The eICU does not visually monitor every bed all the

time Three situations where a bed is monitored:

The eICU nurse is evaluating the patient

The eICU detects an urgent or life threatening problem

The bedside personnel press the eCare Access (Panic) button

The eICU is there to ASSIST the bedside team,not to take over the care of the patient The eICU will ALWAYS defer to the bedside team

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Advantages

Patients Decreased mortality

Potential for earlier diagnosis with advanced trendingand smart alerts

Less downtime Decreased LOS Cost

Morbidity

It costs the patient NOTHING for this service

There are no billing codes for the eICU Startup costs and first years monitoring provided by a

grant from Delta Health Alliance (DHA)

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Advantages II

Physicians Fewer (if any) routine phone calls at night & on

weekends youll be fresher in the morning

Experienced intensivist is a phone call or a press ofthe eCare access (Panic) button away

If you have specific worries or want somethingspecific done to your patient(s), let the eICU know

Notes by the eICU physician are instantly available oneCare Manager or printouts

If you do get called out at night, at least it will be forsomething billable

Better documentation for Physicians (legal medical)

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Advantages III

Nurses Nurse to nurse communication

Troubleshooting equipment problems

eICU can watch patients for the nurses when they areaway from the bedside

Nurses can ask experienced nurses in the eICU for advice

eICU can make the call to MORA

eICU can run down lab work, imaging results while thenurse stays at bedside

Nurse to physician communication If the nurse is contemplating calling the bedside physician,

the nurse can talk to the eICU physician For Category II, the nurse can get the necessary orders

from the eICU physician

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Advantages IV

Hospital administration Decreased mortality

Decreased LOS

Cost savings

Institution of best practices

DVT prophylaxis

Ventilator bundles

Decreased VAP

Compliance with Joint Commission mandates

Better Medical documentation (DRG)

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Unintended Consequences

Physician buy-in is extremely important. Themore the physicians use the system, the

better the results

After using the system for a period of time,hospitals tend to take care of sicker

patients on their on rather than transporting

them

Nurse retention improves

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Summary

Mississippi will never have enough intensivists, theeICU extends the ones we have. eICU appears ideal

for Mississippians

Physicians get more rest and are relieved of

routine calls in the middle of the night Nurses get to spend more time nursing

Most importantly, however, the patients are the

ones who stand to benefit the most

Community also potentially can benefit whenattempting to recruit (Physicians, Nurses, Business)

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Anatomy ofeCareMobileCamera & Microphone

2-Way Video Screen

Speaker (not visible)

Retractable Network

Cable for WiredVersion (hidden)

Retractable Power

Cord (hidden)

Battery PowerMonitor

eLert Button

Laptop Screen

Keyboard & Mouse

WLAN Antennae

(Wireless only)


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doug campbell md panel presentation nov 3 2010

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