A new cooperative project between East Georgia Regional Medical Center and Emory University links the Statesboro hospital's ICU by audio, video and continuous computer charting of patients' vital signs to Emory's 24/7 critical care medical staff.
Nights and weekends, 7 p.m. until 7 a.m. Monday through Friday, and from 7 p.m. Friday until Monday morning, Emory's critical care physicians will make rounds electronically to check on some of the hospital's sickest patients, said East Georgia Regional CEO Bob Bigley.
"Of course there are always doctors here that are on call," Bigley said. "We have exceptional physicians, two of whom are board-certified in critical care medicine and pulmonary medicine. But they aren't, of course, here (at the hospital) 24 hours a day, seven days a week."
So East Georgia Regional, which treats an unusually high number of severely ill patients for a hospital its size, was seeking to reduce late night calls to its doctors, which can leave them exhausted the next day.
The 150-bed hospital, which maintains a 12-bed regular intensive care unit and added a 12-bed coronary care unit two years ago, also was looking for ways to speed recovery times in the ICU and reduce waits for admissions to critical care.
During the past decade, East Georgia Regional has added services in cardiology, gastroenterology and robotic-assisted surgery. These have increased the number of critical-care patients, as have transfers from smaller hospitals in neighboring counties who previously would have gone to cities such as Savannah and Augusta.
Partnership with Emory
Meanwhile, Emory University's Center for Critical Care was awarded a $10.7 million grant by the Centers for Medicare and Medicaid Services, or CMS, for a project to rapidly train and deploy non-physician critical care providers. So, in an arrangement Bigley started working out more than a year ago, East Georgia Regional became part of that project.
The hospital's ICU Acute Care Nurse Practitioner, April Hargett, went to Emory for six months advanced training in critical care, and other nurses received training in how to interact with the e-ICU system and Emory doctors.
Emory is known worldwide for its critical-care capabilities, as seen in its recent treatment of Ebola patients. In addition to Emory University Hospital, which alone is licensed for 587 beds, Emory Healthcare operates six other hospitals and several clinics and has more than 16,000 employees.
Precision digital camera
Each of the 12 rooms of East Georgia's regular ICU now has a precision digital camera that can zoom in on a patient to hair-counting resolution. The camera is mounted above a TV screen that makes the communication two-way. In addition, there's a literal big, red button that EGRMC staff press to summon the Emory nurses, and potentially doctors, to enter the room virtually.
Besides making their virtual rounds, Emory's physicians are now accessible to EGRMC nurses on the night and weekend shifts. Even during the day, when East Georgia's own doctors are on duty in-person, the Statesboro hospital's nurses are able to call on Emory critical care nurses when they need an extra pair of eyes or have a question.
Before Emory physicians and nurses can be involved in the care of any EGRMC patients, they or family members responsible for their care must give consent, which was not a problem in the system's first few days of operation.
"A hundred percent of the patients have agreed to that, and a hundred percent of the patients and the family members have just been delighted with the additional service and coverage," Bigley said.
The tele-ICU equipment was installed at East Georgia Regional Medical Center beginning in July and made fully operational last week.
Nurses were skeptical at first, said Diana Ray, RN, clinical director in the ICU. But that changed quickly when they used the system in specific cases, she said, such as when an Emory nurse helped Ray and another nurse identify the cause of a problem indicator with a patient's chest tube.
The computerized charting of patient data reportedly adds to the positive reception.
"Our nurses are loving it," Ray said. "They're actually finding that it's more efficient. They spend more time at the bedside than outside charting."
How the system works
In a demonstration in a briefly vacant ICU room, Ray pushed the big, red button. It lit up, a doorbell rang - which would alert a conscious patient or family members of a virtual visit - and within a minute, Emory nurse Era Napier, RN, appeared on the screen.
Wearing a headset, Napier said she was watching other monitor screens. The Emory nurses provide an extra layer of support for on-site nurses and patients and can check to make sure the patient is safe when vital signs fluctuate, she explained.
"We can give the nurse a call to see if she can go in and check the patient to make sure the patient is safe, or call the nurses station to have somebody else go in and check," Napier SAID.
A portion of the CMS innovation grant paid for training EGRMC nurses and other startup costs. But East Georgia is paying Emory a monthly fee for the service, also with an initial discount from the grant.
"There is no additional cost to the patient, or an insurance company, for this," Bigley said. "Nobody's billed for this. It's an improvement in quality of care with no additional cost. The hospital absorbs that cost."
East Georgia Regional obviously has very limited experience with e-ICU thus far, but Bigley said it has been successful in other hospitals.
"The system has been shown to decrease mortality, decrease length of stay, decrease complications and improve the overall care and recovery of that patient," he said.
Al Hackle may be reached at (912) 489-9454.