Tonight is Allison’s first night off orientation in the ICU. She is concerned about her patient, but unsure of how to proceed. She looks around the unit and everyone seems busy. Then, Allison remembers help is just the push of a button away.
Moments later, a camera in the ceiling in the corner of the room starts to move and the video image of an experienced critical care nurse, an eRN – a member of the tele-ICU team – appears on a TV screen. The nurse on the screen is able to see and hear everything Allison can and is able to provide support and guidance. If needed, the eRN has access to an intensivist who can intervene on behalf of the attending physician.
This scene plays out in critical care units around the country in hospitals that have implemented a tele-ICU as part of their critical care delivery model.
The first tele-ICU was implemented in 2000 by Sentara Hospital in Norfolk, Va. In the 16 years since, over 50 such command centers have been opened across the country. Implementation of a tele-ICU program with an intensivist-led team assists in bridging the gap between intensivist supply and demand and has been shown to decrease ICU and hospital mortality and shorten both hospital and ICU length of stay.1
Tele-ICU technology utilizes specialized software with visual alerts and algorithms that allow clinicians to detect subtle changes and trends in patient physiology. Another component of tele-ICU technology is two-way audio and high-definition video. This equipment links the eRN with caregivers and patients and allows the eRN to visualize the patient and in-room equipment. The in-room camera allows the remote clinician to zoom in and assess very small items, such as the type on an IV bag or pupillary response.
Extra Layer of Care
As part of the Geisinger Health System’s commitment to excellent care, the Geisinger eICU program opened in February 2010 and now covers 128 ICU beds across the Geisinger Health System and its outside partners. The Geisinger eICU program is staffed 24/7 with experienced critical care nurses and support staff.
To be considered for an eRN position, nurses must have a minimum of three years of critical care experience and have obtained their CCRN within 18 months of hire. Some of the nursing staff work solely in the tele-ICU department. Others work part time in the ICU and part time in the tele-ICU.
The eRN role is a relatively new role in critical care and is still evolving. As in the scenario above, the eRN is able to act as a mentor and resource to the bedside nurse, especially to those who are new to critical care. At the start of each shift, the eRN makes rounds using the camera to assess any safety concerns and get a visual baseline of each patient.
A key role for the eRN is to use the specialized software to monitor patients for adverse trends in physiology and intervene by contacting the bedside RN. If the bedside RN is already aware of the trend, the eRN is able to offer assistance by calling a provider or by looking in on the nurse’s other patients.
It is important to note the tele-ICU staff members are not a replacement for the bedside team. In many instances, additional bedside staff are needed after the implementation of the tele-ICU. The necessity for the additional staff members may be in response to the need for a hands-on provider for urgent and emergent procedures or in response to higher patient acuity and increased throughput.
Nighttime coverage includes an intensivist (eMD) from 7p.m.-7a.m. in addition to the eRNs. Because the majority of the ICUs are staffed during the day with intensivists or attending physicians, staffing the tele-ICU at night with an intensivist allows for the continuation of the plan of care for each ICU patient.
If concerns arise, the eMD is able to make timely interventions and follow the plan that was set by the daytime physician or make changes as the patient’s condition dictates. The eMD may also implement best practice orders if needed for preventive measures such as vein thrombosis prophylaxis, stress ulcer prophylaxis, and ventilator-associated condition prophylaxis.
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Nurses interested in working in a tele-ICU tend to be those who enjoy change and working in an environment with new and upcoming technology. Another group drawn to the tele-ICU are those who have difficulty meeting the physical demands of the traditional ICU environment.
The tele-ICU is the perfect match for experienced RNs who can’t meet the physical demands of the ICU, but who want to stay in an environment where they can use their critical care knowledge.
As the stresses on bedside nurses continue to grow and the pressure to provide the best patient experience continues to mount, the role of the eRN becomes increasingly vital to the critical care environment.
Through the collaborative efforts of this team, patients, and their families can benefit from the duality of ICU/tele-ICU care. Geisinger Health System recognized this benefit and designated the Geisinger eICU Program as a standard of care for all ICU patients. This designation provides an additional layer of patient safety for all critical care patients.
With the assistance of the eRN, Allison is able to perform additional assessments for her patient, and they decide it is necessary to involve the MD. The eMD evaluates the patient and places orders to intervene.
With just the push of a button, Allison is able to get the assistance and resources she needs to help her patient, and the patient receives early intervention.
- 1. Fifer, S, Everett, W, Adams, M, & Vincequere, J. (2010). Critical Care, Critical Choices: The case for tele-ICUs in intensive care. Boston, MA: Massachusetts Technology Collaborative and the New England Healthcare Institute.
Janet Rushing is operations director, eICU Program, and Tracey Kopenhaver is clinical coordinator/educator in the eICU Program at Geisinger Health System, Danville, Pa.