eICU - page 2

Does anyone work in one of these new parts of the ICU care? Was wondering...looking for opinions of this. Thanks... Read More

  1. by   Celia M
    Dinith88
    Let me clarify our sitiuation. We are a small ICU in a rural facility, we have 1 general surgeon, 2 cardiologists and several IMs and peds docs. No invasive cardiology except pacemaker and just recently AICDs, no neuro, renal, hematology, GI on a full time basis.All our sick newborns are stabilized in our nursery and flown to Loma Linda NICU.. The nearest level III is 90 mins away by road. We do not keep these patients by choice but have them until we can transport them, typically hours in the case of peds, some are too unstable and sometimes the weather does not permit immediate transfer. With the growing difficulty in finding beds at tertiary level centers we are seeing longer waits to transfer our patients that need a higher level of care, sometimes dyas, once it was over a week. So having the support of an eICU would be helpful.
    Last edit by Celia M on Sep 19, '05
  2. by   Dinith88
    Quote from CVRNof4
    The eICU intensivist gave suggestions to the respiratory therapist and bedside intensivist and guess what...after a 1/2 hour of those at the bedside attempting to intubate (luckily they were able to bag the pt. enough to maintain a good sat) they were able to with the suggestions of the eICU doc. Pt. is doing fine.

    .

    I dont beleive this nonesense. HOpefully you were there to enlighten me. What SPECIFICALLY did/could the Eicu doc suggest that made the difference???

    Other than watching in some kind of weird medical-voyeuristic(sp?) monitor-tech kind-of way, how could he do anything?..Unless the 'intensivist' and RT's at bedsie were absolutely incompetent and inexperienced (a SCAREY thought)...or did the eicu camera zoom-in on the patients vocal-cords during the attempts?? :spin:

    Even with an absolutely strange (unlikely, extrodibnarily rare) example like this, i'm not swayed. Eicu's are a waste of time.
    Nice...in an expensive monitor-techy type of way i suppose...if you beleive monitor techs are helpful...
  3. by   DidiRN
    I like our EICU personally. Very nice and convenient when you do not agree with intern/resident who is on, you can always give them a call and ask them. Physicians in our EICU are critical care docs who actually work in our ICU, not interns/residents. The nurses in our EICU, for example, can help you watch any patients if you have another one who is crashing, and you can't or the other staff can't watch them; I work in a very large, spread out (too spread out, in my opinion), high acuity ICU. They are for the most part good resource people, most are highly experienced critical care nurses who have worked on this unit and can help you with any questions/concerns. I don't have a bit of a problem with them whatsoever, and am glad I have someone to help me watch my patients.
    There have been some who do not and still do not like the EICU though.
  4. by   Dinith88
    Quote from DidiRN
    I like our EICU personally. Very nice and convenient when you do not agree with intern/resident who is on, you can always give them a call and ask them. Physicians in our EICU are critical care docs who actually work in our ICU, not interns/residents. The nurses in our EICU, for example, can help you watch any patients if you have another one who is crashing, and you can't or the other staff can't watch them; I work in a very large, spread out (too spread out, in my opinion), high acuity ICU. They are for the most part good resource people, most are highly experienced critical care nurses who have worked on this unit and can help you with any questions/concerns. I don't have a bit of a problem with them whatsoever, and am glad I have someone to help me watch my patients.
    There have been some who do not and still do not like the EICU though.
    Hey Didi, i understand what you're saying (and the other posters who are proponents of Eicu). My point, i guess, regarding the Eicu is that they're only as useful as a well-versed monitor tech would be. In situations where patients are being cared for by 'doctors in training'...as in a big teaching center(like yours?), perhaps the idea is to keep a close eye on these guys???

    I do understand the 'concept' of eicu, i just beleive the limitations of such a set-up are enormous...and are, in my estimation, a misuse of resources that could be better spent elsewhere.

    Perhaps a better use for this would be an eIMCU/eSTEPDOWN/eTelemetryeMedsurge, etc...where nurses have more than a few patients and may have better excuses for not being 'on top' of their patients' trends/rhythm's/wave-forms.... but then again, are there any valid excuses for that?

    lastly, do you (or other proponents) think an 'eER' would work??
    Why or why-not???
    And can these same reasons be applied to eIcu? why or why-not?
  5. by   bellehill
    Quote from Dinith88
    Hey Didi, i understand what you're saying (and the other posters who are proponents of Eicu). My point, i guess, regarding the Eicu is that they're only as useful as a well-versed monitor tech would be. In situations where patients are being cared for by 'doctors in training'...as in a big teaching center(like yours?), perhaps the idea is to keep a close eye on these guys???

    I do understand the 'concept' of eicu, i just beleive the limitations of such a set-up are enormous...and are, in my estimation, a misuse of resources that could be better spent elsewhere.

    Perhaps a better use for this would be an eIMCU/eSTEPDOWN/eTelemetryeMedsurge, etc...where nurses have more than a few patients and may have better excuses for not being 'on top' of their patients' trends/rhythm's/wave-forms.... but then again, are there any valid excuses for that?

    lastly, do you (or other proponents) think an 'eER' would work??
    Why or why-not???
    And can these same reasons be applied to eIcu? why or why-not?

    An eER would not be effective because the patient does not stay for an extended length of time and there are multiple doctors available if the patient starts crashing. On our unit we have nobody at night except a moonlighter/intern who usually defers to what we suggest. Last time I checked RN does not equal MD. I am looking forward to pressing a button and being connected to a doc immediately (and have that doc know what they are talking about). Yes, I can handle my patients very well but a safety net is always nice.

    The cameras in these rooms are so powerful that they are able to check pupils if there is a neuro change. It isn't designed to replace the nurse or watch the nursing care that is given. Like I said before, if you don't like it then don't use it.
  6. by   sirI
    eICU is an excellent concept .... especially in the rural areas. The eICU has come in handy on more than one occasion where I am located.
  7. by   Dinith88
    Quote from bellehill
    An eER would not be effective because the patient does not stay for an extended length of time and there are multiple doctors available if the patient starts crashing. On our unit we have nobody at night except a moonlighter/intern who usually defers to what we suggest. Last time I checked RN does not equal MD. I am looking forward to pressing a button and being connected to a doc immediately (and have that doc know what they are talking about). Yes, I can handle my patients very well but a safety net is always nice.

    The cameras in these rooms are so powerful that they are able to check pupils if there is a neuro change. It isn't designed to replace the nurse or watch the nursing care that is given. Like I said before, if you don't like it then don't use it.
    1)One of the supposed 'strengths' of the eicu is that a patient can be monitored while the nurse is away attending to other things...
    Why wouldn't that work in an er? Rhythms become bad, patients begin to crash, labs come back bad, etc...while the er nurse (for example) might be pinning down a crying child in another room/bed/curtain...

    2) An eicu is not a substitute for a doctor, correct. And, as was mentioned by another poster, an icu may have an intensivist on hand 24hrs a day...so, would this mean an eicu wouldn't be needed there?

    3) What if the ER were staffed by lots of interns, etc..and other doctors-in-training...wouldn't the eICU offer an 'expert' opinion PRN? or..are those not needed in an er?? (take the eicu intubation assistance from a previous post as an example)

    4) If a pt NEEDS a doc@ bedside (for line insertion, intubation, sutures, etc.) then the Eicu or Eer wont help a thing./... in icu or er

    5) If the idea of an Eer sounds silly to you...now you'll understand why an eICU sounds silly to me...

    6) Come on! a camera that zooms in to check pupils??? So...the staff has to position the pt's head just right...then shine a light as directed by the eicu-tech...PLEASE..how absurd...
    unless of course the camera is like a robot out of star-trek and can position itself/the patient...shine a light....etc...all while the bedside nurse is away tending to other stuff...
  8. by   bellehill
    I can't change your mind and you can't change mine so we might as well agree to disagree. This eICU is coming in about 1 week to my floor whether I want it to or not so I might as well keep an open mind. I have heard mixed reviews; I am excited but that might change once I work with it. Either way it isn't my choice.

    One last thing, the people working the cameras are not techs, they are ICU nurses and doctors. Please don't think a tech would be taking your place at the bedside.
  9. by   Celia M
    Quote from bellehill
    I can't change your mind and you can't change mine so we might as well agree to disagree. This eICU is coming in about 1 week to my floor whether I want it to or not so I might as well keep an open mind. I have heard mixed reviews; I am excited but that might change once I work with it. Either way it isn't my choice.

    One last thing, the people working the cameras are not techs, they are ICU nurses and doctors. Please don't think a tech would be taking your place at the bedside.
    Bellehill, I'd love to hear how the implementation of eICU goes for you and of any experiences, good or bad you might have as this is something that is being considered where I work. Celia
  10. by   bellehill
    Quote from Celia M
    Bellehill, I'd love to hear how the implementation of eICU goes for you and of any experiences, good or bad you might have as this is something that is being considered where I work. Celia
    No problem, I will let you know!
  11. by   CVRNof4
    Here is another example of how the eICU has worked. Last night while I was in charge a pt. was admitted-SBP 55. The Intensivist that was consulted did not call back after one hour of numerous pages and calls to his home. Called the eICU and received orders for volume and pressors as needed. As RNs we cannot just start a drip...and I really am offended by Diniths post-definately not one open for change. What if you go to computerized charting like we did a few years ago...what negative things will he/she have to say about that, or getting rid of NAs, or pt. to RN ratio changes for productivity? Come on-until you have used it you cannot have anything to say
  12. by   Dinith88
    Quote from CVRNof4
    Here is another example of how the eICU has worked. Last night while I was in charge a pt. was admitted-SBP 55. The Intensivist that was consulted did not call back after one hour of numerous pages and calls to his home. Called the eICU and received orders for volume and pressors as needed. As RNs we cannot just start a drip...and I really am offended by Diniths post-definately not one open for change. What if you go to computerized charting like we did a few years ago...what negative things will he/she have to say about that, or getting rid of NAs, or pt. to RN ratio changes for productivity? Come on-until you have used it you cannot have anything to say
    Please dont be offended by my posts...i'm mostly just voicing my opinion.

    However, eICU is still stupid...and now both of your examples are bad...

    ...if i had a patient crashing, you can rest assured i'be be hanging dopa, or giving a bolus ...in fact IT would be excpected of me...i wouldnt walk away from a crashing patient like that to call a doctor...

    If, as you say, you let the patient lay there for one hour hypotensive, in need of volume and pressors...(one HOUR?)...your eICU failed you, your 'on-call intensivist' failed you (and should be written up for this!) and you may have failed your patient...you should know better. If that guys kidneys are fried (among other things) it'd be on your shoulders. If your hands are really that tied...something's wrong... (An HOUR? and admitted w/SBP55???)

    In that 'scenario', the eICU was merely an alternative 'on call' doc...whose role could've been filled by any doctor with a beeper. NO need at all to spend a ga-zillion dollars on that technolegy(sp?)...(and ongoing salaries to 'eICU nurses (who sit on their bums and stare at screens...)...and intensivists who probably nap..???) Money much better spent on additional bedside staff...tech. upgrades (BEDSIDE-tech :chuckle ) ...inservicing...etc. ad nauseum
  13. by   CVRNof4
    Quote from Dinith88
    Please dont be offended by my posts...i'm mostly just voicing my opinion.

    However, eICU is still stupid...and now both of your examples are bad...

    ...if i had a patient crashing, you can rest assured i'be be hanging dopa, or giving a bolus ...in fact IT would be excpected of me...i wouldnt walk away from a crashing patient like that to call a doctor...

    If, as you say, you let the patient lay there for one hour hypotensive, in need of volume and pressors...(one HOUR?)...your eICU failed you, your 'on-call intensivist' failed you (and should be written up for this!) and you may have failed your patient...you should know better. If that guys kidneys are fried (among other things) it'd be on your shoulders. If your hands are really that tied...something's wrong... (An HOUR? and admitted w/SBP55???)

    In that 'scenario', the eICU was merely an alternative 'on call' doc...whose role could've been filled by any doctor with a beeper. NO need at all to spend a ga-zillion dollars on that technolegy(sp?)...(and ongoing salaries to 'eICU nurses (who sit on their bums and stare at screens...)...and intensivists who probably nap..???) Money much better spent on additional bedside staff...tech. upgrades (BEDSIDE-tech :chuckle ) ...inservicing...etc. ad nauseum
    First off it was not my pt.-I was in charge of the unit and had other nurses to help out...Believe it or not the pt. was not symptomatic (bilateral amps to the groin, ESRD, spends most of the time in the hospital...). As RNs I do not remember learning or being licensed to hang pressors without an order. The eICU MDs can only give orders on certain pt.s in our CVICU-they are catergorized. This was not a category III pt. where they could freely give orders. They went above and beyond when I called them-not the RN at the bedside. The so called intensivist who did not answer his pages was fine with the orders. Later that night he did not return a call on a pt. that was admitted for over three hours. You can have your opinion, but obviously the Magnet hospital I work at finds a need for it...and yes we are one of the number one heart centers in the Midwest, unfortunately some of the overflow pt's we receive have to have incompetent intensivist (and not the eICU MDs-they are only allowed to do so much in the unit I work in). Best of luck to you in your nursing career.

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