eICU: Useful or useless?

eicu nurse · Nov 7, 2004

Just read an article in Nursing Matters here in WI. Aurora Healthcare is implementing eICU, a remote monitoring system, at two hospitals in it's network. This consists of intensivists and critical care nurses at a remote facility miles away from the critical patient's bedside providing constant surveillance with monitors that provide real-time labs, H&P/consults, VS and two-way radio/one way video of the pateint at the bedside. If an emergency occurs, the intensivist can access the data, see the patient and speak with the nurse at the bedside and give orders while waiting for the on-site intensivist/other md to arrive. Any thoughts on this?

I currently work in the eicu in Houston texas and it is great. we are very effective in adverting bad changes in patient status such as electively intubating a patient before they code while the attending physcian is enroute, replace labs without waking some crabby physician i the middle of the night,or have the right answers for a resident or nurse who is not sure of themselves:balloons:

my2sons · Nov 7, 2004

I work in a busy Houston SICU that is currently being outfitted with the latest and greatest "eICU advantage." It really peeves me, since I have been lobbying for (without success) computerized charting for this entire hospital ICU system. The answer every time has been lack of money. Installing the software, hardware, cameras, communication links, etc cannot be very cheap , although I believe that there is a lot of grant money that we're getting. We currently have a lengthy (though incomplete) quadrafold graphics and the time spent charting is ridiculous. I have proposed a time study to quantify the amount of time that is spent on charting, but it is always knocked down. I have been in ICU for over 10 years. The hospital I worked at for eight of those years did do a time study, and the results were so impressive that they stopped the study and went to computer charting then and there. It freed up so much time to be at the bedside. THIS is how you avert problems folks, being present at the bedside. The only advantage that I see is that it allows hospitals to put LESS STAFF with LESS EXPERIENCE at the bedside. I'd bet that this whole thing emerged from the FRIGHTENING new combination of inexperienced nurses with inadequate ICU orientations. I think eICU is a safety catch to save patients from inexperienced nurses. Of course you need someone to watch over these people! I can't stand being in charge anymore, it is too stressful to watch over the new people! Just my opinion, any comments?

robred · Nov 8, 2004

Bingo! That was my thought exactly! I also feel this is a safety vavle to save patients from inexperienced nurses. Who will those nurses be....med/surg, OB, rehab or whoever else will be involuntarily floated. I can hear it now, "Don't worry...the pateint is being monitored by a doc across town." Well, I hope that there are several docs monitoring cuz emergenicies, of course, are indiscriminate to whoever else is crashing. Indeed, circling the drain is best prevented by 1) being well-versed in one's specialty, 2) being at the bedside....observing, following trends, looking for the glimmer of change that raises one's eyebrow and 3) using your partenr's as sounding boards when in doubt (as many a physician will do). I feel the eICU is only an expensive, fancy means of trying to lower morbidity...rather than addressing the root cause fo a problem. How sad.

heart queen · Nov 9, 2004

I did a quick thread on this. We have been using it for months

pros- eicu is hooked to the monitors, so the nurse and/or doc turns on the camera and assesses the patient, while your're tied up and don't know that the 2nd degree hb is now turning ugly.

- all those scenerios as above (well if adequate staffing was mandatory, I'd be in the room LONG before these guys, but again all those scenerios like above, the DO catch changes quickly.

- residents who piss around like a symptomatic unrelieved chest pain on a high risk surgical, the eicu doc had to give me my basic requests of more morphine and lopressor IV, as we were getting no where the eicu doc called the cardiac surgeon, and in 30 minutes we now had an IABP at the bedside, (surgeon and the residents wouldn't listen to me the lowly nurse, but the intensivist lit a fire under their a**.

-crazed vent or OD patients, where the teaching team is so mismanaging, ordering one mg. of IM haldol, when three nurses are laying over the patient trying to maintain the airway. You hit your emergency button, the doc is there on the camera and they override any and all stupid as well as lacking orders, then fax you the orders they gave you.

They "virtually" walked through a resident inserting a transvenous pacer, when the attending refused to come in for a hr of 20 and the resident lacked the adequate # of check offs to insert himself.... don't get me started on this night... ugh!

cons- they call you to correct stupid crap like wake up a stable r/o to put their pulse ox. back on, they call you to discuss the antibiotic therapy, when you're knee deep in ..... and you can't do it then.

We only have and intensivist until MIDNIGHT, well, after midnight is when the lowly residents become fearful of calling attendings, as you now are lacking backup, saying you call you wussy or I will!

worst of all having an intensivist who is so fearful of stepping on an attendings toes, like placing a crashing 44 yr. old ARDS pt. with a PaO2 of 40 maxed on pressure control, to make the decision and place them on an oscillator.

So for a start up of $4million, I can't see how we'll ever justify the costs. If we had adequate nursing staff, most if not all are beyond qualified to babysit the newbie docs, we wouldn't need a $4mil. baby sitting service....

sorry, off the soap box. This has many plusses and minuses, but you MUST have an intensivist on the hours in which an attending is most likely to give the teaching staff grief for this to truely work.

Lets hear from some more success stories, and I can be more positive about this... which is in its infancy stage here.

sue

eicu nurse · Nov 10, 2004

hi

i currently work in a eicu where we have intensivist coverage 20hrs per day, they are not there from 7a11a when it is believe that attending MD,s are in the units.If the eicu has a ? about a drug they should resource the pts MAR or call the pts attending. we have had several times when so called stable observation patients with pulse ox problems have been found by the bedside ICU to actually be in distress requiring intubation and had pul embol, or the patient who's bp "isn't really that low" who when the nurse went to the bedside found the patient had pulled a cordis out and had lost 2 nits of blood in the bed I know how irritating those calls can get because I still work at the bedside @ least 1x a week but now also understand the reason for it..

eicu nurse · Nov 10, 2004

eicu nurse · Nov 10, 2004

Yes the e-icu will be coming to STICU the computer system does allow for charting at the bedside on portable computers that are now being processed so that will be available for the bedside nurse and medical staff to use. the vital signs are continously fed into the ecare system and are always real time current and all vital signs are availble with merely change the scale.you are right when you say we are a safety catch for both the new nurse or the old tired frustrated nurse who is ready to sceam because of new nurses crazy residents no time to eat let alone go to the bathroom

as far as reducing staffing the opposite is actually occuring in the units we are in because we can provide information that shows peak admission/procedure times,busiest days trendings that indicate a need for MORE staff. we will never be utilized to cut staff that has been approved by the CEO of the hospital system. as a charge nurse you could call eicu and inform them that you would like their help with a guiding or assisting a new/float nurse through a procedure or just keep an eye on a nurse you are worried about.

heart queen · Nov 15, 2004

I have to agree with eicu nurse. This is not an attempt to increase the patient load, yet is a side alley to prove unsafe staffing, as eicu holds their own acuity and can further justify an unsafe assignment, although not the purpose.

Another misconception is that management is spying on bedside nursing through eicu, and they're "watching you're every move". We'll they're so hung up on papers and trying to recount each pt. day that there isn't the time or energy for that.

I strongly feel that instead of eicu, if a qualified and experienced intensivist was to be hired on staff from 7a-7p, you would not need to pay a nurse, plus and intensivist. In addition, the skills for line insertion from centrals to RV pacers to swans would facilitate the learning process and patients wouldn't be allowed to crump out until the attendings showed in the am. As bedside RN's you could argue sedation, vent weaning as well as aggressive therapies and not have the fear factor of inexperienced residents calling inexperienced attendings while your patient is dying.

ABG's q1hr, and no one is certified to place a line.

10 sticks later, pressure in the 50's and no one has the skills to place the central. You can't do this over the phone!!!!!

IMHO, each facility needs to run a 7 day 7p-7a intensivist, and prove how this has failed long before a multi million $$ system implement to band-aid the issues is passed.

Provide adequate staffing to support the senior staff to monitor and mentor the newbies, from nursing to MD's and it's more cost effective through an intensvist and adequate staffing than eicu. want the fiscal ##'s? I'll be happy to share them.

BTW, because we won't spend $400,000 for two intensivists, my facility chose a start up of $4,000,000.00. Then the salaries, then the bennies add to. Not counting facility renting, monitors, computers, supplies ect. In addit time spent by bedside facing this duplicate info and having to put I&O's in the computer with re-faxing day's orders and a minimum of two calls per shift. this is the loose breakdown. you do the math.

I love our eicu, because my facility is too short sighted to do the right thing and this is the next best alternative to ensuring safe and optimun patient care.

sue

cscvrn · Feb 18, 2006

Do you still think your eicu is worthwhile, and does it impact your decision to stay or leave your current position??

Thanks

sharann, BSN, RN · Feb 19, 2006

Is this as effecive as properly staffing a unit safely? Does it cost less to have the e-icu or an extra RN at the bedside? Just asking?

eicu nurse · Feb 19, 2006

Yes I believe the e-icu is still effective in caring for the patient. We have gathered stats that have proven a decrease in the mortality and morbidity in the units we are ,monitoring and in fact the case mix has increased and the patients are now leaving the units sooner. We also have documentation revealing that our earlier identification of imminent changes in patients vitals or lab trends have decreased the amount and severity of secondary insults to ICU patients that affect long term outcome. We have also aided units in obtaining additional staff that they were previously unable to hire because of lack of documentation. Our intensivist is able to care for up to 100 patients at all times due to the system can yours do that at the bedside.