Doctors and nurses monitor dozens of intensive-care patients in seven hospitals 24 hours a day via flat-screen computers in a command center at Banner Desert Medical Center in Mesa.
High-tech cameras in ICU rooms at the hospitals allow the doctors to check a patient’s breathing, analyze their pupils, read the medicine labels on IV bags or the pressure gauges at their bedsides — and even give patients and their family encouragement through a speaker in the wall. In the near future, two-way cameras will allow patients to see their doctors. For now, a small “R2D2”-shaped camera moves around the room.
In May, Banner Health embarked on the second phase of its new iCare program, which may be the future of care for its most critically ill patients. Using eICU technology created by VISICU, Banner Desert is the first hospital in Arizona to use the software to allow intensive-care specialists to provide additional care from iCare’s command center.
The new telemedicine does not replace bedside doctors and nurses, but instead adds another layer of supervision for the most fragile patients whose conditions can change quickly. It also helps alleviate a severe shortage of ICU doctors.
Specialists in the iCare’s command center have access to electronically generated test results, X-rays and reports, and can use the software to track any changes in vital signs to help diagnose a health issue before it escalates to an emergency.
“The team here is looking at the sickest patients on an hourly basis, and asking, ‘Is everything OK?’” said Robert Groves, medical director for iCare Banner Health. “Are there any trends we should be worried about?”
The computers and health care workers analyze data constantly, he said, “instead of, traditionally, we often learn about something after it happens. It’s very proactive.”
It’s technology that the National Coalition on Health Care and the Institute for Healthcare Improvement says has dropped the mortality rate among ICU patients in East Coast hospitals by 25 percent and reduced lengths of stay by 17 percent.
Banner has spent $70 million seeking that same success. The cost won’t be absorbed directly by patients, but through the savings of treating patients more efficiently, said Dr. Larry Spratling, chief medical officer for Banner Baywood Medical Center in Mesa.
“Published articles show cardiac arrests were reduced,” said Spratling, a former intensivist who was among the hospital officials to investigate and urge approval of the iCare program. “Outcomes are improved. We were dumbfounded by what they could do, how much intervention was possible from a remote location.”
There are anywhere from 3,000 to 7,000 intensive care doctors, called intensivists, in the United States, far below the need, Spratling said. Putting available intensivists in one room where they can monitor and track patient progress in several hospitals, and give guidance from another location, is one way to overcome that shortage.
The first phase of the eICU in Banner began in January 2006, and the second phase started May 17. A third phase is planned to go online in the next eight months, and will include Gilbert’s new Banner Gateway Medical Center, scheduled to open by September.
Intensive care doctors watch over patients from 7 p.m. to 4 a.m., and experienced critical care nurses oversee the center during the day. Eventually, doctors will work 24 hours a day.
There are 126 beds that can be monitored now from iCare. They are at Banner Estrella Medical Center and Banner Good Samaritan Medical Center Neuro ICU, both in Phoenix; Banner Desert’s cardiac ICU, Banner Mesa Medical Center, Banner Baywood Medical Center and Banner Baywood Heart Hospital, all in Mesa; and North Colorado Medical Center in Greeley, Colo. In the next two to three years, Banner plans to provide the telemedicine care to all of its 391 ICU rooms.
Nurses say the extra eyes focused on their most critical patients have not only boosted care for those patients but even provided mentoring for new nurses. It helps them prevent patients from pulling out tubes or standing up too quickly.
Doctors can analyze late-night tests. One doctor in the center helped health care workers in Colorado save a man whose lung had collapsed by giving directions over the in-room speaker.
And one patient who had asked not to be resuscitated had a nurse hold his hand during his final moments, thanks to an early alert that he was dying.
“It’s just another layer of watching,” said Marilyn Loos, a clinical manager at Banner Baywood ICU.
It also puts family members at ease, allowing them to go home and rest as their loved one recovers, she said.
“It’s just one more level of care, but it doesn’t replace the nurse at the bedside.”