The doctor is 'in' the virtual ICU
By Shannon Sollinger
Marilyn Fioravanti thought she might get bored monitoring intensive care patients from a computer screen miles from the bedside.Not a problem, she said Sept. 3 from her post at the Inova Health System enVision unit in the Verizon building on U.S. 50 in Fairfax. She's got plenty to do, it's all interesting, and if she needs a change of pace, she can step on the treadmill in the corner while another nurse covers for her, or take a walk around the building.
There are stations for eight in the unit, and three nurses, all intensive care specialists, were on duty that day. They were assisting bedside nurses in five hospitals in Northern Virginia by monitoring patients' heart rates, breathing, blood pressure, oxygen levels and lab results.
They see everything the bedside nurse sees, and they see it when the nurse is in the hall or in with another patient. A room-mounted camera gives them a view of the patient and everything in the room – down to the expiration date on the patient's juice container.
It's the eICU, the brainchild of two Johns Hopkins doctors. From the enVision room in the Verizon building, Medical Director Dr. William Jackson and a staff of 21 keep watch 24 hours a day over more than 100 intensive care unit beds in the Inova system.
"We see, in real time, all the telemetry monitoring the EKG, the labs, the notes," Jackson said. Even more important, he said, they can see a trend developing – the patient is getting better, or the patient is getting worse. If the latter, they can intervene earlier.
When no doctor is available at the bedside, he can write orders and prescribe medications for a patient in any of those faraway rooms. He can zero in on a patient's eyes and check pupil dilation. He also can talk to the patient, to a family member and to the bedside staff through the camera.
Jackson is an intensivist, a physician board-certified in intensive care. Ideally, each hospital in the country would have intensivists on duty every day to tend to every patient.
But there are only 6,000 intensivists in the country -- not enough to go around. Fewer than 15 percent of hospitals have dedicated intensivist staffing, according to VISICU, the Baltimore-based developer of the eICU.
"We provide an extra layer of monitoring above and beyond what you get in any other community hospital system," Jackson said.
Margaret Copeland, of Alexandria, has been on duty with enVision for two years. This day, she was watching over patients at Inova's Loudoun, Mount Vernon, Alexandria, Fair Oaks and Fairfax hospitals.
The virtual nursing station is "really awesome," Copeland said. She pointed to a yellow triangle on her screen, next to a patient's name. The computer was telling her to check in on that patient.
If a closer look reveals a problem – low blood oxygen, a kidney problem, an unplugged ventilator – she can alert the nurse on duty at that hospital.
Inova points to a study published in the Journal of Critical Care Medicine for at least partial justification of the expense of the system, which cannot be billed to the patient.
With an eICU system complementing bedside care, according to the study, 25 percent fewer patients die in the intensive care unit, and the number of days a patient stays there drops by 17 percent.
The system has passed all government requirements for protecting patient privacy. A bell goes off in the intensive care unit room when the camera activates, Jackson pointed out, and the camera makes noise when it swivels.
"We are very sensitive to patient privacy,” he said. “We are not indiscriminate with the camera. "
Contact the reporter ssollinger@timespapers.com