eICU ever heard of this?

Hoozdo, ADN · May 31, 2010

I work in an ICU that has EICU implemented. I think it is pretty cool. No

problems getting orders, called EICU and have a Dr. there to write orders.

If you need a doctor immediately, there are cameras in every ICU room. You

push a button and there is a doctor.

You will definitely be monitoring remotely. I rarely interact with the EICU

nurses. I know they do a work up of every admit for sepsis protocol and

figure out APACHE scores. If the docs are all tied up, I sometimes speak to a

nurse and ask them to ask for orders for this and that and why.

I definitely wouldn't mind working in an EICU. No families and no lifting.

CNL2B · Jun 1, 2010

It appears these are being implemented in hospitals all over the country. My facility has one in the works to monitor our smaller hospital's ICUs in the system. No experience in one -- but I think it would be interesting.

APRN., DNP, RN, APRN, NP · Jun 2, 2010

I've worked in an e-ICU, and it was very nice because you didn't have to spend time spinning your wheels with contacting the MD with a change in status. You push a little button on the wall, and it's kinda like a "call button" for the e-ICU. The camera's in the remote "e-ICU" can zoom in on IV fluid rates, what meds are hanging, what the urine looks like, what the vent settings are, how much fluid has accumulated in the ventriculostomy drain, what the cardiac/ICP monitor readouts are, etc. It cuts down on a lot of wordy descriptions since "A picture is worth a thousand words". The doctors sends a prescription over the fax and "boom" there's your order.

As an aside, having a conglomorate of conversations with third parties about e-ICU, it sounds like you really have to know your stuff, but it's a sweet position to have.

rn/writer, RN · Jun 2, 2010

Golly Moses, I hope this doesn't mean the powers that be will try outsourcing nursing jobs to Timbuktu now.

BellaInBlueScrubsRN · Jun 2, 2010

Our facility has an eICU program. I like them. Very handy. Not sure what it would be like to be a nurse with one though. Often times, they seem like to go-between for the bedside nurse and the eICU doc. And maybe just a lot of paperwork, vitals trending. This is just a guess.

wanderlust99 · Jun 3, 2010

Thanks for the replies. I guess it's mostly paperwork - which sounds appealing and dreadful at the same time:), maybe someday I'll do something like that but I don't know if I have the experience needed quite yet. As a travel nurse, I've never actually seen an eicu. I don't know, we usually have an anesthesiologist in the ICU 24/7 and that I really like.

Thanks again!

telenursing · Jul 9, 2010

I have worked in an eICU since 2003. We monitor over 400 ICU beds between two hubs. It is like being the charge nurse of a large ICU except your patients can be down the street or hundreds of miles away. It allows our health system to leverage nurse expertise and intensivists. There is a shortage of intensivists and their specialized training in critical care can save lives according to research. Watching how care is delivered in multiple ICUs has allowed me to see how much variation in care exists. Evidence-based practice is beginning to take hold and I think that the eICU has helped our hospitals realize that care wasn't as good as we thought.

The eICU nurses in our hub have on average 15 years of critical care nursing experience. About 50% have their CCRN. We have competencies for and collect data on severe sepsis, hypothermia for cardiac arrest, lung protective ventilation strategies for ARDs and ALI, CORE measuers and much more. As nurses in the eICU we have the opportunity to gain more knowledge about evidence-based practice, participate in and learn more about research, and we feel like we are on the cutting edge of care. Unfortunately we struggle to be accepted as part of the care team. We try to be supportive to the ICU nurses but when we try to raise the safety flag or provide our assessment findings we are sometimes treated unkindly.

I hope you visit the eICU before you make a decision to not apply. It really is an innovative way to not replace nurses at the bedside but compliment care in a different way with a different view.

apocatastasis · Jul 14, 2010

Our hospital has an eICU. It's owned by our hospital system and staffed by nurses from within our system... they're also outsourcing to other hospitals.

I can only speak for our hospital system and from the opposite end of the camera from telenursing. In my experience, whether doctor or nurse... we all hate it. They've spent millions of dollars on what is nearly universally considered to be a waste. Several doctors have forbidden them from ordering anything on their patients. One of our cardiothoracic surgeons forbids them from even looking at his patients.

I don't usually speak for other people, but in this case, I am comfortable speaking for my whole ICU, because we all entirely resent their presence. General consensus is that at best, they're useless, and at worst they're intrusive and obnoxious. In the year that we've had the system, they have never contributed anything to any patient under my care. Never. Unless you count strife between physician and physician, physician and nurse, and nurse and nurse to be important interventions to improve the care of the patient. (I don't.)

I could go on, and on, and on, but the bottom line is that I really can't say enough bad things about it, and I CERTAINLY wouldn't want to work there.

telenursing · Jul 20, 2010

The Institute of Medicine (IOM) has informed us that about 100,000 errors that result in harm to pateints occur each year. The ICU is a complex environment with many decision making opportunities and data suggests that the error rates there are very high. On average physicians and nurses in the ICU do not use evidence-based practice to drive care. They instead use outdated "recipes" for care based on experiential knowledge and social interaction. "I have done this before and it worked, or I like you so I will trust that you know what you are doing." As a critical care nurse with 15 years of experience I hate the competitiveness and terriorialism of the ICU. It creates barriers to best care and ultimately harms patients.

The airline industry in the 1970's had many more air accidents than they do today. Why? What changed? Several things: Heirarchy in the cock pit was dismantled. In the 1970's even the co-pilot was not allowed to question the pilot. Pilots were the "cowboys" of the sky. They alone knew what was best. If they didn't have to listen to their own crew then they definitely were not going to listen to some air traffic controller!" But then the FAA stepped and regulated the airline industry and the role of the air traffic became an intregal part of the safety of air travel. Why? The air traffic controller can see things that the pilot and crew cannot. They have knowledge and a view that is different. I have listened to the conversations between the air traffic conrtollers and the pilots (you can do this on United flights) and I am very pleased to hear the professional and well orchestrated flow of communication. It makes me feel safer that they are all working together to get me to my destination in a safe manner.

Do our patients deserve less? I found the following quote that challenged me to change my attitude about caring and advocating for my patients. "The ethical demand that we hold another person's life in our hands; this sovereign expression of life is given to us, before and beyond our control with expressions of trust, love, caring, honesty, forgiveness, gratitude, and so on, beyond ego fixations and obsessive feelings that are negative expressions of life." (Logstrup 1997) I think that until we can stop defending our care and start looking at ways to improve it through transparency, better care coordination, team collaboration and application of evidence based care will never acheive the level of patient care advocacy that we are called to. Instead of fearing that a camera is there looking over my shoulder telling me how to to do my practice, why not embrace the fact that someone else could maybe see something that from the bedside is not as visible. A subtle change in a patient's condition can be a sign of impending doom. Why discount the expertise of an Intensivist (specially trained and boarded in critical care) along with a team of expert nurses (most eICUs have a requirement of 5 years of critical care nursing experience to work there)? How can that be good for patient safety and care?

Just my 2 Cents,

Telenursing

OkieICU_RN · Jul 22, 2010

Telenursing -

I think you are right on. The ICU can be a dangerous place to be, for patients, nurses, physicians. The concept of the eICU is something that really intrigues me. I think it would be fantastic to work in a unit that utilized this service/concept; even to be a nurse in the eICU helping patients through a cameral lense.

Also, I appreciate your comments as they are dead on when it comes to evidence based practice. One of the most impressive articles I ever read was "The Checklist" and I think it's worth posting a link here for those who have not. It seems to me that if it saves lives and complications, it is worth it. I despise the fact that egos are ever present in the ICU. It must become a place of mutal respect and commraderie.

http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande