Originally Posted by connyrn

[b] They'll have your lab results before you! .

Is it me, or this not a dumb a concept??? Why in the world would lab results be first relayed to a remote location rather than to the bedside critical-care team?!?!?! Even if a panic value is resulted, why would the laboratory not report this immediately to the unit???

eICU is a waste of time...

Originally Posted by Dinith88

Is it me, or this not a dumb a concept??? Why in the world would lab results be first relayed to a remote location rather than to the bedside critical-care team?!?!?! Even if a panic value is resulted, why would the laboratory not report this immediately to the unit???

eICU is a waste of time...

What I took the post to mean is that they are sitting in front of the computer and will be able to look up your labs for you if needed, no way do the results get called to the eICU that isn't what it is designed for.

eICU is meant to help the ICU nurse, doctor and patient; if you don't need help don't use it. I for one am excited to have a doctor available all night who knows something about critical care rather than first year interns who are shell-shocked about everything.

To Dinith 88

Originally Posted by bellehill

What I took the post to mean is that they are sitting in front of the computer and will be able to look up your labs for you if needed, no way do the results get called to the eICU that isn't what it is designed for.

eICU is meant to help the ICU nurse, doctor and patient; if you don't need help don't use it. I for one am excited to have a doctor available all night who knows something about critical care rather than first year interns who are shell-shocked about everything.

Here is a great example of how the eICU helped a patient the other night...The pt. had extensive cancer of the mouth, neck and a total resection of his mandible. The pt. went into a respiratory arrest. The code team of all qualified personel responded; however they could not intubate this pt. orally or nasally. 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.

Many of the small rural hospitals that our eICU is affiliated with have new grads or not as experienced nurses. Often times they will utilize the eICU.

I agree with the above post-if you believe that you do not need it-don't use it. I have worked in a CVICU for many years and believe I can care for my pt. or two without any help, but when you are put in a situation where both pt.'s are crashing-believe me the help of the eICU is invaluable to me. This is including heart, lung transplants and VADs. The surgeons where I work have even used the eICU at night to manage a pt. when appropriate.

As nurses we do have to be open to change and technology. When our hospital went to computerized charting (Emtek-not Cerner) we all were resistant. Now I would never do it any other way.

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.

Originally Posted by 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??

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...

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.

Originally Posted 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.

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?

Originally Posted by 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.

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.

Originally Posted by 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...