• MARCH 2008 FEATURE ARTICLES •
Remote Monitoring/Care:
Case History
The Critical Link
Remote monitoring of ICU patients can save lives and decrease patient length of stay across rural America.
Hays Medical Center (HMC) is a 192-bed
not-for-profit tertiary care regional health center serving
northwest Kansas. It has the region's only open-heart program
and is its sole tertiary care facility. Like many healthcare
facilities in rural areas, HMC faced budget limitations and
resource shortages that challenged its capacity to handle all of
its critical care cases. Patients sometimes needed to be sent
outside the region.
With acuity levels in the region on the rise,
an eICU program presented a viable alternative to adding
clinician resources. John Jeter, M.D., CEO of HMC, and a former
emergency medicine physician, became familiar with the benefits
of eICU when a family member received care from a neighboring
hospital that had an eICU program.
Solution
As an alternative to investing in its own
eICU program, HMC investigated options for contracting with a
health system partner that could provide the remote monitoring
services. The search led to Saint Luke's Health System in Kansas
City, Kansas. HMC selected Saint Luke's based on the results
that were being achieved there, the organization's relative
proximity and the fact that Saint Luke's was not considered a
direct competitor to HMC. The live eICU link was established
between the two hospitals in April 2006.
Saint Luke's had implemented VISICU's eICU
program in January 2005. Many health systems share Saint Luke's
commitment to the program as a solution for addressing the
growing nationwide shortage of intensive care physicians and
critical care nurses. The program leverages an intensivist-led
care team, supported by telemedicine and remote monitoring
technology, to monitor hundreds of patients remotely in support
of the bedside team. eICU clinicians track vital signs and
laboratory trends and guide ICU staff interventions to avoid
potentially devastating patient complications. Studies have
shown that this type of care model can reduce ICU mortality by
as much as 25 percent.
With the eICU link, intensive care nurses and
physicians at Saint Luke's can remotely monitor critical care
patients at HMC. As vital signs are checked, physicians can
communicate directly with HMC patients and ICU staff through a
video camera and speaker installed at the bedside. Nurses in the
HMC ICU in need of immediate help with a patient can press a
button mounted on the wall of the room to get direct physician
attention. Additionally, family members may speak with the Saint
Luke's support team through the audio/video conference
connection.
In addition to HMC, the Saint Luke's eICU
center also monitors patients at four Saint Luke's hospitals in
the Kansas City area. Overall, the system monitors more than 90
patients at a time, leveraging the experience of one physician
and two nurses working within Saint Luke's Health System, as
well as the critical care expertise embedded in the VISICU
system. Ultimately, the eICU program can be expanded to cover
more than 300 patients as needs dictate.
Results
As a result of the support of the remote eICU
center, local physicians are aided in caring for their most
critical patients. Patients who require immediate intervention
can be prioritized and addressed more quickly, and HMC's
continuous access to critical care specialists has improved
referral confidence throughout the region and enhanced community
awareness — the sickest patients in western Kansas can now
receive critical care close to home.
The eICU program has led to a significant
improvement in quality performance metrics at HMC. In the five
quarters since the program's implementation, ICU mortality
dropped by 50 percent, while ICU length of stay decreased by 18
percent. (Results are as compared with APACHE III
severity-adjusted predicted values). Evidence of the impact on
patient satisfaction is the number of complex cases that now
remain at HMC rather than being transferred to another facility.
This provides a clear testimony to the positive impact of the
program on physician recruitment and patient satisfaction — an
impact that is reflected by rising case mix acuity and revenue.
Pre- and post-implementation data show a rise in the case mix
index from 2.77 before program implementation to 3.02 after
implementation, with a corresponding revenue increase of 15.3
percent.
Conclusion
HMC is one of the first independent rural
hospitals in the country to use contracted eICU services to
demonstrate a sustainable model for enhanced quality
performance. The results reflect those being observed
nationwide, across many hospitals, where ICU and hospital
mortality are being reduced by an average of 25 and 22 percent,
respectively.
In an area where acuity levels continue to
rise and demands are ongoing for open-heart and other tertiary
care specialists, this new technology has been integral in
enabling HMC to continue to sustain its growth in a
cost-effective and quality-efficient manner. Since implementing
the eICU program, HMC has recruited two new cardiology
specialists and additional nurses to its care team. The nursing
staff has been quick to embrace the new technology due to the
direct benefits they are realizing from enhanced access to
specialists and the corresponding impact on improved patient
care. This has contributed to increased nurse satisfaction and
retention. HMC's access to the eICU program and its recent
staffing additions have enabled it to expand its critical care
services, including an expanded cardiac step-down unit and an
additional ICU.
HMC continues to make positive strides in achieving its
vision to be the best tertiary care center in rural America.
Through Jeter's focus on doing "what is right for the patient,"
the benefits are coming back home to HMC and its community.
"This model is proving to be a sustainable model for care in
rural America," he says. "We are working with our legislators to
expand government support and funding for this type of
initiative, which is likely to become the defacto standard for
critical care moving forward."