Digitally connected care and remote patient monitoring in the intensive care unit at Emory Healthcare in Atlanta have been very successful, an Emory executive says.
Over three years on an initial grant of $11 million from the federal government, telehealth and related technologies generated about $18 million in total savings of three years, Timothy Buchman, founding director of Emory Critical Care Center and medical director of Emory eICU Center medical director, told attendees Friday at World Congress 2019 Care Coordination & Technology Conference in Atlanta.
But Emory also learned some key lessons on what it takes to build up a successful digitally enhanced ICU. For starters, he discovered the price tag to find and implement the technology, Buchman told attendees. “The hub portion is going to be in the seven-figure range and the spoke portion in the high six figures,” he said.
Using a hub-and-spoke approach worked well for Emory. That’s because a central hub can monitor multiple ICUs across hospitals within a health system and send alerts and updates to providers for individual patients, according to Emory. “Intensivists and nurses certified in critical care triage respond to actionable alerts,” Emory eICU director Cheryl Hiddleson told attendees. “Bedside teams carry out interventions.”
Emory operates a substantial eICU program that incorporates 13 locations and 158 beds at five hospitals. Since 2013, Emory’s eICU has treated 37,694 patients incorporating 124,919 days of care.
But a key lesson leaned over many years of running an eICU is that striking the right mix between human care and technology is critical. “If you put one more monitoring device next to a patient nurses have to use, they will come at you with a machete,” Buchman says.
How providers monitor patients during the day vs. at night, especially late night, also is different, Hiddleson said. “Our clients need substantial support at night and that is hard on our staff,” she told attendees.
To accommodate different staffing needs for different shifts caring for intensive care patients, Emory developed a project that involved relocating one nurse and one physician to Australia for 6-9-week rotations, and incorporated shifts that ran from 9 am to 9 pm, 10 am to 10 pm and 11 am to 11 pm to cover the 7 pm-7 am shift in Atlanta. . “The night shift was covered mostly from daylight,” Hiddleson said.
What’s next on the development agenda for the eICU at Emory is using applications such as artificial intelligence to predict the onset of sepsis—or life-threatening illness caused by infection—in ICU patients in real time. “We use the data within the eICU system to build an artificial intelligence sepsis expert,” he told attendees.
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