Electronic ICU
eICU® - the Electronic Intensive Care Unit
Studies have shown that round-the-clock coverage by physician specialists in hospital ICUs is key to better patient outcomes. But with less than 6,000 of these doctors actively practicing in the U.S., our nation faces a serious challenge providing this level of coverage.
That’s why, as part of an ongoing commitment to improving quality care and patient safety, Sutter Health is investing $25 million in a remote high-tech surveillance system known as the electronic Intensive Care Unit (eICU®) program. Learn more below.
Is the eICU technology proven?
Sentara Healthcare, a multihospital system based in Norfolk, VA., has operated an eICU for several years. Sentara continues to see impressive improvements in ICU outcomes, including a 25 percent reduction in severity-adjusted hospital mortality for ICU patients and a 17 percent reduction in ICU and hospital length of stay.
In Sacramento, Sutter General Hospital and Sutter Memorial Hospital "went live" with the eICU program in early 2003, and physicians have already reported positive results.
What are the credentials of the eICU staff?
Physicians who work on the eICU team are trained intensivists with full medical staff privileges and ICU credentialing at one of the Sutter hospitals being served by the team. These physicians also have special credentials at all Sutter hospitals they monitor so they can electronically write notes and orders for patients in each location.
How are our nurses’ and physicians’ roles/responsibilities changing through the introduction of this model of care?
The eICU concept does not attempt to change the role of our nurses and physicians or the number of professionals working in the unit. Rather, it aims to make ICU work more manageable.
The admitting physician continues to have primary responsibility for the patient's care, but some details of implementing that care or modifying it as the patient's condition improves or worsens may be delegated to the eICU physician by the admitting physician.
The eICU staff are highly supportive partners for the bedside nursing staff and admitting or consulting physicians. They can relieve the nursing staff of many phone calls to physicians as well as confirm intent and details of orders.
What are the roles and responsibilities of the eICU physicians?
The eICU physician provides continuous vigilance, early intervention and ongoing care as delegated by the attending physician with the goals of supporting the patient care plan and decreasing ICU-related morbidity and mortality.
How do attending physicians delegate care to the eICU physicians?
There are four levels of supplemental care under which the attending physicians can request support.
Level I: Initiate only emergent interventions for life-threatening conditions. Notify the attending physician immediately of these events and all other situations warranting medical attention.
Level II: Initiate emergent interventions for life-threatening conditions and minor non-emergent therapies. Contact the attending physician for all other situations warranting medical decisions.
Level III: Initiate emergent interventions for life-threatening conditions, minor non-emergent therapies and maintain therapies outlined in existing patient treatment plan. Contact the attending physician for clinical decisions requiring a major change in the plan and for all major events.
Level IV: Initiate emergent interventions for life-threatening conditions as well as minor non-emergent therapies, maintain therapies as outlined, and initiate new therapies as needed. Notify the attending physician of major changes in patient status.
What protocols are followed to resolve conflicts that might occur between on-site and offsite staff members?
The attending physician continues to be the final authority for the patient's care.
How is staff trained on this technology?
The eICU and ICU staff receive special training in the technology, protocols and teamwork connected with the eICU model. Training curricula and guides have been developed by VISICU (the eICU vendor), and have been customized by the Sutter eICU Implementation Committee.
What protocols are used to address a patient’s wishes outlined in his/her Health Care Directive?
This information is recorded in the eICU admitting/cover sheet data so the patient’s wishes are referenced and followed.
How are patients and families educated about the new technology and video cameras in their rooms?
For patients who know they will spend time in the ICU following a procedure, information is available from their doctors' offices. They also are briefed during the hospital admitting process when necessary consent forms are signed. New ICU brochures contain information about the eICU model of care and use of technology.
How does the hospital ensure patient and staff privacy while using the video and audio components of the system?
The eICU staff informs the nursing staff that they intend to use the camera for a specific reason. Nursing staff can alert the eICU team if it’s not an appropriate time to use the camera. Additionally, the video and audio tapes are not archived. A green light turns on, a bell sounds, and the camera lens rotates toward the patient to indicate readiness for use.
What back-up systems are in place to ensure safe data transport and collection?
All eICU data that is required to be saved is incorporated into the existing back-up and recovery systems currently deployed by our facilities. This includes daily incremental back-ups and full weekly back-ups.
Are patient records secure?
Yes. All data that resides in the permanent record is accessed from within the highly secured Sutter Health wide area network. Numerous security and user authentication tools are used to protect systems and ensure patient data protection.
Is technology-based data included in the patients’ permanent records?
Patient data generated through the eICU program is the same data already generated at our hospitals. The technology electronically organizes patient data for rapid review of trends and calls out specific data selected by the eICU staff.
Does the eICU technology do more than transmit patient data to remote sites?
The system allows for immediate access to a vast amount of current evidence-based medical data. Staff in the ICU and the eICU system can review this information to confirm medical decisions as well as continually improve clinical quality.
eICU® is a registered trademark of VISICU, Inc., www.visicu.com.
The Sacramento Sierra Region implemented the first eICU program in early 2003. The region’s remote monitoring unit will develop the capability to monitor patients at other Sutter Health affiliates. Future Bay Area remote monitoring units are being planned.