Staffing An Intensive Care Unit From Miles Away Has Advantages

Staffing An Intensive Care Unit From Miles Away Has Advantages

11:56am May 08, 2015
Registered nurses Cassie Gregor (from left), Camellia Douglas and Mike Montalto monitor patients in intensive care units scattered around North Carolina.
Registered nurses Cassie Gregor (from left), Camellia Douglas and Mike Montalto monitor patients in intensive care units scattered around North Carolina.
Kevin McCarthy/Carolinas HealthCare System
  • Registered nurses Cassie Gregor (from left), Camellia Douglas and Mike Montalto monitor patients in intensive care units scattered around North Carolina.

    Registered nurses Cassie Gregor (from left), Camellia Douglas and Mike Montalto monitor patients in intensive care units scattered around North Carolina.

    Kevin McCarthy/Carolinas HealthCare System

  • One of the screens in Richard Gilbert's hospital room is a TV. The other is an eICU screen, which lets him see and converse with an extra nurse who checks on his care.

    One of the screens in Richard Gilbert's hospital room is a TV. The other is an eICU screen, which lets him see and converse with an extra nurse who checks on his care.

    Michael Tomsic/WFAE

Recovering from pneumonia is an unusual experience in the 10-bed intensive care unit at the Carolinas HealthCare System hospital in rural Lincolnton, N.C.

One of the screens in Richard Gilbert's hospital room is a TV. The other is an eICU screen, which lets him see and converse with an extra nurse who checks on his care.

One of the screens in Richard Gilbert's hospital room is a TV. The other is an eICU screen, which lets him see and converse with an extra nurse who checks on his care.

Michael Tomsic/WFAE

The small hospital has its regular staff, but Richard Gilbert, one of the ICU patients, has an extra nurse who is 45 miles away. That nurse, Cassie Gregor, sits in front of six computer screens in an office building. She wears a headset and comes into Gilbert's room via a computer screen.

A doorbell goes off before the camera turns on, to alert Gilbert that the nurse is looking in. They chitchat as Gregor monitors Gilbert's vital signs, asks how he's feeling and if there's anything he needs.

Carolinas HealthCare System monitors ICUs in 10 of its hospitals from this command center near Charlotte. There are usually seven to nine critical care specialists on hand in the center. Nurses are here around the clock; doctors work nights, and everyone still spends time at the actual hospitals.

Carolinas HealthCare started this project about two years ago and says it's good for staff and patients.

For one thing, because medical staff at the command center can maintain a constant focus on patients, the command center is quiet — none of the bells and whistles going off that most ICUs need to alert nurses and doctors down the hall that they're needed. Dr. Scott Lindblom says it's a nice change of pace.

The peace, he says, "makes it a much more pleasant environment actually to work in than what we're used to — the usual chaos of the ICU."

Qiana Gadson, a nurse at the command center, says the approach has advantages for patient care, too.

"There are things that I'm able to view here — trends that I'm able to view here — that I'm not able to view at the bedside," she says.

Nurse Kimberly Purtill agrees.

"We might see a trend up with their white blood cells," Purtill says, or "a trend up with their temperature, and their blood pressure going down." All those symptoms might be warning signs of an infection.

"If you were off yesterday as a bedside nurse, and you're on today, you don't have the picture from yesterday," she continues. But the command center staff has easy access to the data on the computer screen, she says, so it's easy to give the bedside staff a heads-up.

Lindblom oversees critical care for Carolinas HealthCare System and says there are clear signs the virtual ICU is working.

"We're taking care of more patients than we were two years ago," he says, "and across the system, our mortality rate is dropping ... and our length of stay is dropping. It's almost the perfect storm of good care."

Among the 10 hospitals in the program, ICU mortality is down 5 percent and length of stay is down 6 percent. Lindblom says virtual care doesn't get all the credit. He notes the hospitals have also rolled out a program to better manage sepsis, which is a leading cause of death. But, he says, virtual care helps with that program and nearly everything else in the ICU.

Leah Binder is president of The Leapfrog Group, a national advocate for better hospital care. She said the gold standard is to have critical care doctors on-site, not on-camera.

"However, that's not always possible for every hospital and particularly in rural areas," Binder says, "so second to that is a virtual environment."

As technology leads to better care, she says, it could also lead to lower costs.

In the Midwest, Avera Health estimates its virtual ICU has resulted in $70 million worth of savings over the past 10 years. Deanna Larson, who oversees the project for Avera, says that from one hub in South Dakota, Avera monitors patients as far away as Minnesota and Wyoming.

"I think we quit calculating miles a while back," she says, and laughs. "It's a very vast area of land."

Before virtual care, Larson says, complicated cases were often transferred to major medical centers. Now some of those patients can stay closer to home, and that's good for them, their families and the town's economy.

"Keeping 10 or 12 patients more ... means another nursing job that stays local," Larson says, "maybe another lab tech job. What the technology is really doing is keeping those economics closer to home and helping them maintain viability."

In Lincolnton, Dr. Jessica Fox said her ICU has been much busier.

"The unit went from basically having a couple patients, and closing all the time because we were having to transfer so many patients," Fox says, "to now being almost full all the time because we're able to keep patients here."

From his ICU bed, lifelong farmer Gilbert says the more people looking after him, the better.

"That's sort of like me and farming," Gilbert says. "If I've got a five-man job, and I go out there with two people, [I] might miss something." But if you have your whole crew working, he says, "you don't miss anything. You get it done."

This story is part of NPR's reporting partnership with WFAE and Kaiser Health News.

Copyright 2015 WFAE-FM. To see more, visit http://www.wfae.org.

Transcript

MELISSA BLOCK, HOST:

Imagine being in a hospital bed with your nurse or doctor checking in on you from miles away. That's happening in remote hospitals in rural areas - a way of bringing in the expertise of a major medical center. As Michael Tomsic of member station WFAE reports, the practice may also be keeping rural hospitals open and saving jobs.

MICHAEL TOMSIC, BYLINE: Recovering pneumonia is a different experience in the 10-bed ICU in rural Lincolnton, N.C.

(SOUNDBITE OF BELL)

RICHARD GILBERT: Hey.

CASSIE GREGOR: How are you doing, Sir?

GILBERT: I'm doing pretty good today. I'm feeling a lot better.

TOMSIC: Nurse Cassie Gregor's face appears on a screen. She's checking on patient Richard Gilbert through a camera from 45 miles away near Charlotte.

GREGOR: Is there anything I can do for you?

TOMSIC: Gregor wears a headset and sits in front of six computer screens. She's in a generic medical office building, but from there, Carolinas HealthCare System monitors ICUs in 10 of its hospitals. Compared to how ICUs normally sound...

(SOUNDBITE OF HOSPITAL COMMOTION)

TOMSIC: ...The command center is oddly quiet. Dr. Scott Lindblom says it's a nice change of pace.

SCOTT LINDBLOM: There's not any bells or whistles or nothing going off. I mean, it makes it a much more pleasant environment actually to work in than what we're used to - the usual chaos of the ICU.

TOMSIC: The command center is staffed 24/7 with a rotating crew of nurses and doctors who specialize in critical care. Everyone on the team also does bedside shifts. Nurse Qiana Gadson says working in the virtual ICU has its perks.

QIANA GADSON: There's things that I'm able to view here - there are trends that I'm able to view here that I'm not able to view at the bedside that sometimes I wish was available to me.

TOMSIC: Nurse Kimberly Purtill agrees.

KIMBERLY PURTILL: We might see a trend up with their white blood cells, a trend up with their temperature and their blood pressure going down.

TOMSIC: All warning signs of an infection.

PURTILL: If you were off yesterday as a bedside nurse and you're on today, you don't have the picture from yesterday, but we have it in front of us on our screen.

TOMSIC: And it's easy to give the bedside staff a heads-up. Lindblom, who oversees critical care throughout Carolina's HealthCare System, says the virtual ICU is good for patients.

LINDBLOM: We're taking care of more patients than we were two years ago. And across the system, our mortality rate's dropping, and across the system, our length of stay is dropping. It's almost the perfect storm of good care.

TOMSIC: Lindblom says virtual care is saving money, too. This has been true for one system in the Midwest. Avera Health estimates its virtual ICU has saved $70 million over the past 10 years. From one hub in South Dakota, Avera Health specialists monitor patients as far away as Minnesota and Wyoming.

DEANNA LARSON: So I think we quit calculating miles a while back because it's a very vast area.

TOMSIC: That's Avera's head of e-health, Deanna Larson. She says the savings come from reducing mortality, complications and length of stay. Before virtual care, complex patients were often transferred to major medical centers. Now Larson says some of those patients can stay closer to home, and that's good for the local economy.

LARSON: Keeping 10-12 patients more maybe means another nursing job that stays local, maybe means another lab tech job. What the technology is really doing is keeping those economics closer to home and helping them maintain viability.

TOMSIC: Back in Lincolnton, Dr. Jessica Fox says her ICU has been much busier thanks to the remote help.

JESSICA FOX: The unit went from basically having, you know, a couple patients and closing all the time because we were having to transfer so many patients to now being almost full all the time because we're able to keep patients here.

TOMSIC: From his ICU bed, lifelong farmer Richard Gilbert says the more eyes on him the better.

GILBERT: That's the whole idea of farming. If I got a five-man job and I go out there with two people, you might miss something. But if you got all your whole crew, you don't miss anything. You get it done.

TOMSIC: For NPR News, I'm Michael Tomsic.

BLOCK: This story is part of a reporting partnership of NPR, WFAE and Kaiser Health News. Transcript provided by NPR, Copyright NPR.

Support your
public radio station