eICU

Dinith88 · Sep 27, 2005

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

CVRNof4 · Sep 27, 2005

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.

Dinith88 · Sep 27, 2005

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.

So...this frequent-flying asymptomatic patient...required pressors and volume to correct his hypotension when the doc finally called???

Regardless.... The eICU's purpose is to 'monitor' these people..and if the eICU

failed to notice or failed to 'phone in' for an entire HOUR while the patient layed there for 60minutes (because your nurses are unable to correct this without a doctor telling you to) then in my estimation the eICU failed.

Luckily @ most places (including my non-magnet hospital), the ICU nurses have more freedom and are expected to know how to handle things and are covered/protected by standing protocols and orders (for pt's admitted to icu).

bellehill, RN · Sep 27, 2005

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

That is one of the reasons we are looking forward to the eICU. We had that same situation the other night, SBP in the 50's, boluses started, no MD call back for 30 minutes. Unfortunately in this state as, well as yours, RNs are not allowed to write med orders or initiate medications without a doctors order. Were we geting ready to hang Dopamine without an order? Yes. Did we already send an order to pharmacy for Levo? Yes. The nurse put her head on the block hoping that the meds she "ordered" would be okay with the MD when they called back. This is not effective nursing, we are not doctors nor do I want to be. I'm glad to hear the eICU worked so well for your unit, now I am even more excited.:)

bellehill, RN · Oct 18, 2005

Here is an eICU update for those of you who were interested. We have been "live" for one week, of course the acuity on the unit dropped as soon as we went live. The main problem is our attendings not allowing eICU to write orders on non-emergent issues (K+ replacement, temps, low hgb...) but they also don't want to be called in the middle of the night. We are working on that issue. I have not been bothered by the eICU at all. I was floated to ICU the other night and saw eICU in action in a code, it was awesome. The resident needed a cool, level-headed person backing him up and that is what he got. I'm still waiting for the shift it helps me, but like I said, our acuity is very low right now.

Dinith88 · Oct 19, 2005

Here is an eICU update for those of you who were interested. We have been "live" for one week, of course the acuity on the unit dropped as soon as we went live. The main problem is our attendings not allowing eICU to write orders on non-emergent issues (K+ replacement, temps, low hgb...) but they also don't want to be called in the middle of the night. We are working on that issue. I have not been bothered by the eICU at all. I was floated to ICU the other night and saw eICU in action in a code, it was awesome. The resident needed a cool, level-headed person backing him up and that is what he got. I'm still waiting for the shift it helps me, but like I said, our acuity is very low right now.

I still think eICU's are stupid

Teachchildren123 · Oct 19, 2005

No, eICU is not stupid at all.

We are getting soooo much better nouw that we have night coverage on most of the nights.

You have to make pressure so you docs can order electrolytes replacement, give you orders for cultures and Tylenol, Haldol...

Keep on calling them, have your manager work with you to have eICU work with you, this is what's it's all about.:balloons:

Last night, for ex. the nurse at eICU called to ask if we noticed that bed #3 K was 2.4. I told the nurse in ICU the message and asked her if she wanted an order for K runs. She, herself said:"Do you think they'll give me one?"

Sure, they did. We have to get used to have them to support us.

It is so great not to have to awaked the "Grumpy ones"!

Dinith88 · Oct 19, 2005

No, eICU is not stupid at all.
We are getting soooo much better nouw that we have night coverage on most of the nights.
You have to make pressure so you docs can order electrolytes replacement, give you orders for cultures and Tylenol, Haldol...
Keep on calling them, have your manager work with you to have eICU work with you, this is what's it's all about.:balloons:
Last night, for ex. the nurse at eICU called to ask if we noticed that bed #3 K was 2.4. I told the nurse in ICU the message and asked her if she wanted an order for K runs. She, herself said:"Do you think they'll give me one?"
Sure, they did. We have to get used to have them to support us.
It is so great not to have to awaked the "Grumpy ones"!

So umm.. the eicu nurse knew about the hypokalemia before the floor nurse??? scarey.

And i'll never be convinced...eicu's are a misuse of resources. Maybe (in best case scenario) it makes your night nurses more comfortable because they're scared to call the doc regarding a dangerous k level when it's late.

Spend bazillions of dollars...so skittish nurses wont get their feelings hurt when a jerk doc. gets grumpy when you wake him up for a potentially lethal lab result. Hmmm. MOney well spent.

I'm well aware of my inability to convince 'eicu advocates' of it not being all it's cracked-up to be (and not worth the bazillions$$$). HOwever...the truth remains that the eicu is little more than a prying monitor tech that lets doctors sleep in the middle of the night...sure it can give an occaisional order (if intensivist is at the eicu desk) but it can never replace bedside care-givers.

Sure it can 'supplement' things...but at a ridiculous cost...with very little REAL ability that the bedside care-givers need (tell the eicu nurses to come over and clean blood, puke, or wipe a butt...then it may be a little more worth the money)

And how about during the day...do you call the patients doc re: your pt's labs...what if they're napping? or eating? or on a strole??

You know, those guys are on call for a reason...if your scared of 'grumpy one'...you need more confidence...or something...

and please explain why getting an order from an eicu doc is better than obtaining it from on-call doc???

something is wrong here....

Nurse Ratched, RN · Oct 20, 2005

Thanks to Bellehill for keeping us up to date on the progress of her adventure :). Health care quality and associated expenditures are the #1 business issue currently affecting the American economy (and possibly worldwide.) It's interesting to read what efforts are being made to try and increase efficiency without sacrificing patient outcomes. It may or may not be successful long term, but we sure need to do something before the system completely tanks.

Editorial Team / Admin · Oct 20, 2005

Thank you for that comment, Nurse Ratched. Yes, the eICU has been proven to be most beneficial especially in our rural areas. I know there are some issues surrounding its presence for some, but, for the most part, we are very fortunate to have this. I know many are reaping the benefits of this elsewhere as well.

Auri · Oct 20, 2005

We have used EICU for over a year where I am currently working. I must say there are certainly times when I could do without them, i.e. one time I got an admission, had the pt. fully admitted to both their system and ours. pt brady'd down to like 25, sustained, although asymptomatic. I happened to be in the room w/ the pt. the entire time and I guarentee the camera never initiated and I NEVER got any calls saying " umm did you know so-n-so's HR is in the 20's". It was onlt after I called the attending, Medical CCS, HO, Critical care admitting resident ad never got call backs from anyone that they intervened. Pt was a Lvl IV. Which means that EICU could write for ANYTHING from tylenol to levphed for the pt. They could have interveined at any point, yet they werewaiting to see if this pt's MD's called back, which they clearly weren't doing. So i ask... what good were they?? I've noticed some out MD's tend to make the EICU the on call MD for the night so that they don't get 0300 "tylenol calls"which is very nice, unless you have RN's who are unable to properly assess a pt, since the RN's and MD's rely on the bedside RN for about 90% of their knowledge of the pt.

ok

sorry for the tirade.

a

JustMe · Oct 25, 2005

I've read all your arguments for/against eICU. I guess my observation is this: It seems the eICU works well in high volume facilities like an extra pair of eyes for the nurse (who hasn't had a patient fall out of bed even tho the nurse was right next door?). Also works well for those rural facilites who need the expertise in certain situations. I can also envision eICU on the tele units--after all, the hospitals are becoming one great big ICU now that patients are being sent home so early, or not admitted at all. The only patients in the hospital nowadays are the ones who didn't survive 20 years ago.

JustMy observations.