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                                     Opinion

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                                     Opinion

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After weighing the pros and cons of implementing an e-ICU at my institution, I believe this will be an added benefit to enhance patient care. Currently, my unit has round-the-clock coverage by both Nurse Practitioners and Intensivists, so I am interested to see how virtual physicians interact with my team; however, the benefit for myself and my coworkers is vast as we rely on each other for everything due to an absence of aides in the unit. Nevertheless, in a time of heightened cyber security concerns, it is imperative that institutions implementing programs such as e-ICU are cognoscente of security breaches and technological threats to patients. I believe institutions nationwide will begin to partner to establish initiatives such as e-ICU and programs will expand and start anew as healthcare institutions begin to chart their own territory in the world of telehealth. Overall, I believe e-ICU will greatly enhance patient care and, despite "growing pains" associated with the new technology, I believe programs such as this will enhance patient outcomes.

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                                     Cons

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                                     Cons

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Role confusion between virtual staff and in-house staff

Increased reliance on secured, reliable internet connections

Perceived lack of control from nurses and physicians

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                                      Pros

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                                      Pros

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Better ease of blood product and high-risk medication witnessing, and medication wasting

Round-the-clock coverage by an Intensivist

Presence of a neutral third party to mitigate difficult patient situations

Increased detection and treatment of critical illnesses

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                                                                                                                                                                       Summary

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                                                                                                                                                                       Summary

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There is no doubt that healthcare is rapidly changing. New technologies, an increasingly diversified workplace, government-led healthcare, and ever-changing staffing patters all put stress on bedside nurses to ensure they are prepared for the challenges practicing nurses must face today. In this complex industry, one organization had the forethought to position themselves on the cutting edge of nursing care. Mercy Virtual is a new division of the Mercy medical system spread throughout the North American Midwest. In order to combat the nurse staffing crisis that is looming over the healthcare industry, Mercy Virtual was developed as a telehealth organization to provide electronic intensive care unit (e-ICU) services to not only their system hospitals, but hospitals throughout the country (Klingensmith & Knodel, 2016). Much like an inpatient facility, Mercy Virtual nurses work around the clock to monitor patients and provide safe, quality nursing care to patients (Klingensmith & Knodel, 2016). The virtual nurse is able to analyze data and trend patient values that may indicate a worsening condition (Klingensmith & Knodel, 2016). There is also a physician team that rounds on patients, communicates with nurses, and is able to intervene with orders for the bedside nurse to carry out in the absence of an “in-house” physician team (Klingensmith & Knodel, 2016). Gone are the days of waking physicians at home, obtaining unclear verbal orders from care teams, or struggling to find support in a rapidly deteriorating patient situation.
When examining data from Mercy hospital prior to implementation of an e-ICU, 34% of patients who were receiving treatment for sepsis deteriorated to septic shock compared to only 19% post-implementation (Klingensmith & Knodel, 2016). Nurses who work in the Mercy Virtual facility are carefully screened for the correct set of attributes that would be an asset to organizations in which they monitor patients (Klingensmith & Knodel, 2016). In addition to having a minimum years of experience cut-off, Judy Himes, CNO for Penn State Health Milton S. Hershey Medical Center stated these nurses must obtain and maintain licensure in every state in which they monitor patients (personal communication, October 5, 2016). This new telehealth method will allow organizations to reduce negative patient outcomes and maintain cost-effectiveness. My organization, Penn State Health Milton S. Hershey Medical Center has partnered with Mercy Virtual to bring e-ICU services to our organization. Currently, our Medical Intensive Care Unit (MICU) and Medical Intermediate Care Unit (MIMCU)are piloting this intervention and our Heart and Vascular Institute Critical Care Unit is schedule to be the next area to go-live with this technology in early Spring 2017 (J. Himes, personal communication, October 5, 2016). According to Abigail Rudy, manager for the MICU, cameras mounted in each patient room with a means to ring directly to nurses at Mercy Virtual allow bedside nurses in my organization to alert to alert them of assessment changes before they are charted, request they watch a patient while the bedside nurse travels with another, or sign-off high risk medications and blood products in the charting system (personal communication, October 5, 2016). As an organization, we are looking forward to the outcomes of the trial in MICU and MIMCU and are eager to implement Mercy Virtual’s e-ICU house-wide.

References

Klingensmith, L. & Knodel, L. (2016). Mercy virtual nursing: An innovative care delivery model. Nurse Leader, 14(4), 275-279. http://dx.doi.org/10.1016/j.mnl.2016.05.011.

Liz Klingensmith is vice president of patient care/chief nursing officer at Mercy Hospital Ada in Ada, Oklahoma
Linda Knodel is senior vice president/chief nursing officer at Mercy in Chesterfield, Missouri

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Virtual Nursing: Delivery of Electronic Intensive Care Unit (e-ICU) services to hospitals nationwide

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Virtual Nursing: Delivery of Electronic Intensive Care Unit (e-ICU) services to hospitals nationwide