Telemedicine isn’t a new concept. It’s been around for more than 25 years. Basically, it’s the ability to use electronic communications to exchange medical information from one site to another. What’s new is that more than 200 hospitals are now using telemedicine―primarily in intensive care units, but also in emergency departments, postanesthesia care units, critical access facilities, and long-term acute care hospitals―to provide a second set of eyes that can ultimately improve patient care.
Using telemedicine, specially trained staff can observe and assess patients from a remote location or “hub” housed either on the hospital’s campus or, in some cases, many miles away. Cutting-edge technology is networked from a tele-ICU to the bedside providing a backup to bedside care, not a replacement for it. Each patient has an extra set of eyes trained to observe his condition and react if necessary.
How It Works
In tele-ICUs, highly sophisticated communications equipment is installed in the patient’s room and linked to the hub where experienced critical care nurses and intensivists monitor the patient’s condition. The tele-ICU staff has access to the patient’s vital signs, lab results, diagnostic studies, and a detailed medical history and can interface with the ICU’s central monitor to view real-time waveforms. High-resolution cameras can zoom in close enough to examine a patient’s pupils or read the label on an IV bag, enabling the tele-ICU staff to assess each patient closely―even from hundreds of miles away. Microphones and speakers mounted in each patient’s room allow two-way communication between the bedside and the tele-ICU unit. There’s also an in-room button that the bedside team can use to summon help from the tele-ICU staff.
Tele-ICUs are staffed by nurses with years of critical care experience. Excellent communication skills are also critical to job success in the telemedicine environment.
Connie Barden, RN, MSN, CCRN-E, CCNS, is a clinical nurse specialist at Baptist Health South Florida, a six-hospital health system totaling more than 1,500 beds. Each hospital within the system has tele-ICU capabilities. Connie’s hub monitors patients up to 60 miles away.
“The tele-ICU capability provides an additional layer of patient care and support for the busy bedside nurse,” Connie explains. Bedside nurses can summon help from an e-RN at any time. “Every now and then, a family member will even push the button,” Connie says. “It’s reassuring to the staff, the patients, and the family that we are here.”
E-RNs have caught patients climbing out of bed or pulling out IV lines when the bedside nurse is in another room. “We can pick up the phone and warn the bedside nurse immediately,” says Connie. The bedside nurse can also call the tele-unit and ask them to keep a close eye on a patient if necessary.
Benefits on All Sides
Baptist Health South Florida has seen actual vs. predicted ICU mortality decrease by more than 35 percent since 2006 when the tele-ICU opened. Length of stay in the ICUs has dropped by 20 percent. The health system has also tracked more than 60 falls that were prevented in the past year.
In addition to benefits for the patient, the tele-ICU environment benefits nurses on both sides of the camera. Both make valuable contributions to patient care. “One of my most memorable experiences was when a patient came in with an overdose from an unusual substance,” explains R. Daniel Resnick, RN, BSN, CCRN, an e-RN for Baptist Health South Florida. “We were able to find the antidote, obtain it and, most importantly, get the right care to the patient in a difficult situation. The collaboration between the tele-ICU, the pharmacy, and the bedside team probably saved that patient’s life.”
Ingrid Arocha, RN, BSN, at Baptist Hospital’s ICU in Miami, works at the bedside and appreciates the assistance she receives from the e-RNs: “The help we get runs from watching my second patient while I’m off the unit with another patient to helping us think through challenging clinical questions. They are a very useful resource at the bedside.”
And, as Beth Willmitch, RN, BSN, and operations director of the tele-ICU unit at Baptist Health South Florida, explains: “Some nurses are drawn to work in a tele-ICU when they want to lessen the physical and emotional demands of bedside critical care nursing. It can extend the work-life of these highly skilled nurses.”