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Intensive care monitoring system marries information technology, health-care delivery

by Anne Straub
Brevard Technical Journal

Dr. James Shaffer of Health First is the medical director for VitalWatch. Photo by Kathy Hagood, © 2004.

Dr. James Shaffer looks over medical data and notes a gunshot victim has had a rough night in the intensive care unit. The patient squirms on his bed, so Shaffer checks that his intravenous medications include pain relief. He watches the patient's vital signs for a moment before moving on to his next patient.

The scene would seem an unremarkable part of morning rounds except for one fact: Shaffer is miles away from the hospital, looking at the patient and reading data through a computer-based intensive care monitoring system.

Health First installed the system, called VitalWatch, last summer. It's the first electronic intensive care unit in the Southeast, and the eighth operating system in the country.

The eICU provides an additional layer of monitoring to the 62 ICU beds at Health First's three facilities, Cape Canaveral Hospital, Holmes Regional Medical Center in Melbourne and Palm Bay Community Hospital, said Dr. James Shaffer, medical director for VitalWatch.

Critical-care physicians and nurses monitor patients 24 hours a day from a room at Health First headquarter in Rockledge. A nurse or doctor can scroll through patients, watching real-time data on a set of monitors. If a visual check is needed, a camera in each ICU room allows a view of the patient. The nurse or doctor can scan for a view of bedside medications, zooming in to double-check labels. He or she also can communicate with a patient or floor nurse via a microphone. A property of the technology allows the professional to set parameters for each patient, setting the system to set off an alert if, for example, a particular patient's blood pressure falls.

The idea has been compared with an air traffic controller keeping track of different planes from a central location.

Shaffer calls the system a perfect marriage of information technology and health-care delivery. "Function and structure had to come together every day" while the hospital was installing the system, said Shaffer, a 1992 graduate of the Ohio State University College of Medicine. He completed a fellowship in pulmonary and critical care medicine at the OSU Medical Center.

He and Dr. James Palermo, vice president of quality management for Health First, point to two major advantages of the eICU: ease of noting subtle trends in data, and shorter response time.

"We're always here," Shaffer said of the staff in the monitoring center. "There's no beeper, no cell phone. You respond now, not in an hour."

The idea is to add a layer of monitoring without replacing any care. Current staff in the ICU is still needed as the hands on the floor. But those nurses are responsible for all aspects of patient care and can't be in two places at once, Shaffer noted. So having a professional constantly monitoring data provides an added measure of security.

The eICU addresses what's known in the industry as failure to rescue, Palermo said. Patients who die in the ICU usually had a golden time when their vital signs started to trend down and something might have been done to save them. The eICU provides a way to monitor data to spot potential problems and intervene sooner, Palermo said.

The system is predictive rather than reactive, said Bill Super, vice president and chief technology officer for VISICU, the system's manufacturer.

Shaffer wants to have the eICU in place for three full quarters before codifying results. But the hospitals have dozens of anecdotal success stories where critical care staff has spotted possible complications sooner, he said.

The first health-care provider to install an eICU was Sentara Healthcare, which started the system more than four years ago at its five hospitals in Virginia and North Carolina. Sentara officials say the eICU allowed them to save 97 lives in 2003 while it was covering 65 beds.

Part of the motivation for installing the electronic monitoring system is the shortage of critical care physicians, called intensivists. Leapfrog Group, a coalition of businesses that aims to improve patient safety, has called for full-time intensivist staffing in ICUs. But the fewer than 6,000 intensivists nationwide can provide dedicated intensivist care for only 13 percent of the nation's ICU patients without the added technology.

Health First spent a little over $3 million to implement VitalWatch. Running the program will cost about $2 million a year. Health First expects to see improved quality, decreased mortality, and decreased length of stay in the ICU as a result.

Hospitals that add the eICU should see a reduction in cost, VISICU said. "Complication avoidance is really what does it," Super said.

Health First rotates three physicians and five critical-care nurses through shifts in the eICU.

"This really allows you to manager your existing manpower and leverage that with technology to get to the point where every patient is managed by an intensivist," Palermo said.

ICU patients often feel trapped and anxious, and have found the system reassuring, Shaffer said. "Anything you can do that lets them know you're watching, they like," he said.

Cameras don't run continuously and no images are recorded. A tone sounds to alert the patient that the camera has been activated. Data and images are transmitted over Health First's dedicated fiber optic lines, not over the Internet.

Three and a half percent of adult ICU beds are monitored by an eICU, a figure that's expected to rise to 10 percent by the end of the year, according to VISICU. The company sees potential for the technology to be adapted into other adult acute care areas, as well as in neonatal and pediatric units.

For more information, visit www.health-first.org