Enhancing Care and Safety of Critically Ill Patients in the Emergency Department: The Remote Intensive Care Unit

2.50
Hdl Handle:
http://hdl.handle.net/10755/162649
Type:
Presentation
Title:
Enhancing Care and Safety of Critically Ill Patients in the Emergency Department: The Remote Intensive Care Unit
Abstract:
Enhancing Care and Safety of Critically Ill Patients in the Emergency Department: The Remote Intensive Care Unit
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Callen, Lory, RN, BSN, CEN
P.I. Institution Name:Christiana Care Health System ? Wilmington Hospital
Title:Registered Nurse
Contact Address: 501 W. 14th St., P.O. Box 1668, Wilmington, DE, 19899-1668, USA
Contact Telephone:(302) 428-4182
Co-Authors:Rhonda Korpela, RN, ASN
[Clinical Poster] Clinical Topic: A relentless nursing shortage and overcrowded emergency rooms are but two of the many reasons why critically ill patients increasingly receive care in non-intensive care unit (ICU) settings. A number of hospitals limited both in their access to critical care expertise and ability to provide appropriate, around-the-clock monitoring have turned to off-site, or electronic, ICU programs. In 2005, prompted in part by an unavailability of ICU beds, this medical establishment, part of a two-hospital healthcare provider system serving more than 150,000 emergency department (ED) patients annually, became the first in the nation to partner both emergency departments with a remote intensive care unit. Access to continuous monitoring can lead to earlier interventions and thus fewer serious complications and decreased lengths of stay. This paper describes one such program, eCare, and the impact it has had on our patients and staff thus far at the inner city facility of this two-hospital system.

Implementation: In accordance with guidelines and standards of care developed by a multidisciplinary team at this facility, and after extensive staff training, eCare became operational in two of three critical cardiac and trauma rooms in 2005. The program tracks patients' vital trends 24 hours a day, seven days a week, through software sensitive to subtle changes in the patient's condition. Software alerts on computer screens at beside prompt ED staff to make appropriate interventions before changes become serious. The eCare team routinely reviews x-rays, lab results and care plans through cameras hardwired in dedicated rooms, which also allow eCare staff to interact with ED caregivers and patients themselves. A dry erase board displayed in the patient rooms gives patient height and weight, intake and output, intravenous fluids, and other vital information, including names of admitting physician and bedside nurse. The primary ED nurse determines when a patient requires critical care monitoring and notifies eCare by phone or by pressing an alert button in the patient's room. eCare staff enters the patient's information into an electronic system and conducts a head to toe initial assessment via room cameras that zoom in on the patient and transmit displays on IV infusions, vital sign monitors and other patient room equipment. Together with electronically transmitted lab values and imaging reports, the eCare team accurately processes the information. When needed, the remote staff also guide ED nurses with procedures such as setting up a central venous pressure line to the intensivist helping a resident insert central line. Algorithms are provided for addressing routine issues, such as admission, orders, ventilator monitoring, radiology, code blue, etc. Conversations between eCare and ED staff are never recorded and pictures are not taken when the eCare staff is visually monitoring patients on camera.

Outcome: Since implementing the program in 2005, eCare has become fully integrated into the ED process. There have been no disruptions in nurses' work or care of patients, and in fact, the technology has helped to free ED nurses to attend to other patients at the same time. Although pre- and post-implementation measurements have not yet been conducted, ED nurses maintain an increased confidence in their ability to care for critically ill patients knowing they can access the knowledge and expertise of the eCare team. ED nurses also feel reassured that the eCare team "watches over the patient" when they cannot be in the room. At present, information is being gathered on ICU-admitted patients who were downgraded to a stepdown bed without ever entering through ICU doors. Comparative studies on pre- and post-implementation data to determine specific effects of eCare on staff and patients outcomes are planned for the future.

Recommendations: Remote ICUs provide crucial access to critical care expertise in cases where such access is limited or lacking. Continuous monitoring, assessing, and tracking of a patient?s condition can head off the development of potentially serious complications, thereby improving patient safety and reducing lengths of stay. Remote ICUs also boost nurses' confidence in caring for critically ill patients and improve patient safety without disrupting workflow. EDs of every type and size "from Level I trauma centers to small country hospitals" stand to benefit from remote ICUs. Programs such as eCare tend to be costly, but the benefits outweigh the expense. The number one 1 priority of any emergency department, after all, is patient safety and good patient outcomes.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleEnhancing Care and Safety of Critically Ill Patients in the Emergency Department: The Remote Intensive Care Uniten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162649-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Enhancing Care and Safety of Critically Ill Patients in the Emergency Department: The Remote Intensive Care Unit</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Callen, Lory, RN, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Christiana Care Health System ? Wilmington Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Registered Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value"> 501 W. 14th St., P.O. Box 1668, Wilmington, DE, 19899-1668, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(302) 428-4182</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">LCallen@christianacare.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Rhonda Korpela, RN, ASN</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: A relentless nursing shortage and overcrowded emergency rooms are but two of the many reasons why critically ill patients increasingly receive care in non-intensive care unit (ICU) settings. A number of hospitals limited both in their access to critical care expertise and ability to provide appropriate, around-the-clock monitoring have turned to off-site, or electronic, ICU programs. In 2005, prompted in part by an unavailability of ICU beds, this medical establishment, part of a two-hospital healthcare provider system serving more than 150,000 emergency department (ED) patients annually, became the first in the nation to partner both emergency departments with a remote intensive care unit. Access to continuous monitoring can lead to earlier interventions and thus fewer serious complications and decreased lengths of stay. This paper describes one such program, eCare, and the impact it has had on our patients and staff thus far at the inner city facility of this two-hospital system.<br/><br/>Implementation: In accordance with guidelines and standards of care developed by a multidisciplinary team at this facility, and after extensive staff training, eCare became operational in two of three critical cardiac and trauma rooms in 2005. The program tracks patients' vital trends 24 hours a day, seven days a week, through software sensitive to subtle changes in the patient's condition. Software alerts on computer screens at beside prompt ED staff to make appropriate interventions before changes become serious. The eCare team routinely reviews x-rays, lab results and care plans through cameras hardwired in dedicated rooms, which also allow eCare staff to interact with ED caregivers and patients themselves. A dry erase board displayed in the patient rooms gives patient height and weight, intake and output, intravenous fluids, and other vital information, including names of admitting physician and bedside nurse. The primary ED nurse determines when a patient requires critical care monitoring and notifies eCare by phone or by pressing an alert button in the patient's room. eCare staff enters the patient's information into an electronic system and conducts a head to toe initial assessment via room cameras that zoom in on the patient and transmit displays on IV infusions, vital sign monitors and other patient room equipment. Together with electronically transmitted lab values and imaging reports, the eCare team accurately processes the information. When needed, the remote staff also guide ED nurses with procedures such as setting up a central venous pressure line to the intensivist helping a resident insert central line. Algorithms are provided for addressing routine issues, such as admission, orders, ventilator monitoring, radiology, code blue, etc. Conversations between eCare and ED staff are never recorded and pictures are not taken when the eCare staff is visually monitoring patients on camera.<br/><br/>Outcome: Since implementing the program in 2005, eCare has become fully integrated into the ED process. There have been no disruptions in nurses' work or care of patients, and in fact, the technology has helped to free ED nurses to attend to other patients at the same time. Although pre- and post-implementation measurements have not yet been conducted, ED nurses maintain an increased confidence in their ability to care for critically ill patients knowing they can access the knowledge and expertise of the eCare team. ED nurses also feel reassured that the eCare team &quot;watches over the patient&quot; when they cannot be in the room. At present, information is being gathered on ICU-admitted patients who were downgraded to a stepdown bed without ever entering through ICU doors. Comparative studies on pre- and post-implementation data to determine specific effects of eCare on staff and patients outcomes are planned for the future.<br/><br/>Recommendations: Remote ICUs provide crucial access to critical care expertise in cases where such access is limited or lacking. Continuous monitoring, assessing, and tracking of a patient?s condition can head off the development of potentially serious complications, thereby improving patient safety and reducing lengths of stay. Remote ICUs also boost nurses' confidence in caring for critically ill patients and improve patient safety without disrupting workflow. EDs of every type and size &quot;from Level I trauma centers to small country hospitals&quot; stand to benefit from remote ICUs. Programs such as eCare tend to be costly, but the benefits outweigh the expense. The number one 1 priority of any emergency department, after all, is patient safety and good patient outcomes.</td></tr></table>en_GB
dc.date.available2011-10-27T10:31:47Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:31:47Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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