Eicu

Hello - I wasn't sure if the topic was still up today, but I just had to ask...
My dh and I work at a large hospital. I ran across this thread this afternoon and had just never heard of this at all. I hate to ask, but I didn't find too many answers on the net.

Can anyone give me any information on this topic?? I noticed on some of the web sites they had a little information, but not much.

I did pick up the fact that there was video monitoring to prevent injury, accidental extubation, that sort of thing. I did work in ICU at this facility, and they had certain rooms there equipped with that. I also worked part time upstairs on their "medically complex LTAC unit" where all our patients were tubed, some had trachs, all were on cardiac monitors, a lot of extensive wounds, and approx 95 percent were on Dopamine, Dobutamine, Lidocaine, Levophed, or other titratable gtts. We did have art lines, but not quite as often as in ICUs in the main part of the facility. We had half the rooms that were video monitored, and the other half that weren't.

Any info welcome - thanks so much!
Anne, RNC

Puppies,

It seems that in practice, rather than in theory, a lot of EICU's are run very differently. On paper, this idea does seem to make a tremendous amount of sense in some situations. If you work in a hospital with no resident coverage where you have to call an attending for everything, it's obvious how much sense this makes. If you work in a teaching hospital though where there are residents and medical students aplenty, it doesn't make as much sense.

Many of us still feel the role of the EICU is purposely undefined. In some rare cases so far, they have been there to give us an order we needed and they have been an invaluable resource for the resident team when confronted with something complex. From a nursing perspective, it's very mixed. When you are admitting a complex patient that needs a lot of things set up like a-lines, or CVP or pressors, getting a phone call from the EICU to give them a height and weight on your patient can make your blood go from zero to boil in about 3 seconds. Likewise, getting a call asking what you are doing about someone's hypotension while you are already standing there talking to a doctor is equally galling. In our set up, I think the nurses in EICU are tasked with watching a large group of patients and because of this, they rely on their computers to flag critical values and alert them to a situation that may be getting out of control.

Functionally, our program goes something like this, Nurses and Critical Care intensivists monitor our patient vitals, progress notes etc from an off site location. They also have the ability to look into the room with the camera's mounted on the wall and they can also speak to the patient directly. If we, as nurses, are stuck in a crashing patient situation without a resident or attending around, we can hit a panic button on the wall and instantly have a camera zoom in with an open mike that we can communicate with the EICU staff through. Most often, I hear from an EICU nurse when they want a height and weight for a new admit, when I have disconnected a patient for transfer or transport to a test and when the MAR does not reflect common medications like proton pump inhibitors. One time, an EICU Doc did actually call with a worthwhile suggestion to cut a med dose for a renal insufficient patient, but it had already been addressed and his side simply had not reflected that yet. Other than that, my discussions with EICU have not been very fruitful.

By my own admission, I take a lot of pride in what I do and having a stranger call me for something makes me feel like I am being critiqued or "sweated" by an outsider. However, as the nurse who does the physical work of titration, transport, butt wiping and family soothing-I don't see the EICU nurse as an equal partner in what I do. I'm far from thinking I know everything, but from the nurses around me, I have decades of experience to draw from as well as an already established trust and I really don't want to go reaching outside that circle of trust unless I absolutely have to. It's not so much a matter of not trusting EICU nurses, rather it's more a matter of they are "over there" sitting on their butts while we are "over here" doing the heavy work of nursing. That's perhaps not a fair assessment of them, but it's honestly how I feel.

Again, in some situations I can accept that EICU is an awesome tool. For a teaching hospital, not so much.

that's my anyway.

As an experienced Nurse of 14 years, the last 9 spent in the ICU arena and the last 3 in an eICU, I believe that I can share with all concerned that I was at first very resistant to the concept of eICU and felt the "big brother is watching" mindset totally!. However, on the very day that the eICU visited and held an inservice about the eICU concept and it's application to the healthsystem's ICU operations, I changed my views radically and I applied for transfer to the eICU. I have worked there since and I occasionally work shifts at the bedside in our system's hospitals. The eICU provides back up support for all of our ICU/CCU beds and even a mobile unit in an ER. We are staffed with seasoned ICU Nurses with 5+ years of ICU experience and all of our MDs are Pulm/CCM Intensivists. We have experts in all respects with the credentials and work wisdom to perform as wealthy resources for the bedside staff Nurses and MDs alike. Unlike the prevailing ignorant misconception, in our eICU the Nurses are not tele techs although most of us are open heart certified and have no difficulty dealing with complex rhythms and EKGs, our primary function is to monitor patients in terms of trends and collaborate with the eICU MD and the bedside Nurses to promote early intervention and treatment of patients. Multiple scholarly works have been published regarding the many benefits of early intervention. With respect to the concerns of being pestered by the eICU Nurse for simple things, I believe in placing the responsibility of Nursing care for patients directly on the shoulders of the bedside Nurse. He/She has a license and I have no problem allowing them to practice. I do, however, make it well known especially to the "younger" less experienced Nurses, that I am available to help them and I have resources and knowledge to share if they need it. Yes, Virginia, I ocassionally need to call the bedside and ask them to turn a vent monitor toward the camera so I can perform my required tasks, such is life. eICU is here and is not going away. Most often those who squawk the most are the first to call the eICU when their patient is crashing. I would hope that all eICU Nurses do like I do. I try to stay out of the bedside Nurses' way and operate as a resource for them and if their patient is heading for trouble I will call and make sure the healthcare team is all on the same page. I always offer our (eICU) help at any time.

Thanks and if you wish, please post a response to this message.
BTW, the healthcare system I work for regards the eICU Nurse to be the same as the bedside Nurse in terms of salary and benefits there is no difference. They believe in retaining their highly skilled experienced Nursing staff.

Sri