The eICU

What is it?
How does it work?
What is it not?
What are the advantages?

03/2010 1
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The eICU: What is it?
• Computerized monitoring system developed by
VISICU™, a subsidiary of Phillips
– Allows monitoring of individual ICU beds virtually anywhere
in the world from a central facility staffed by physicians
and nurses
– Designed to ASSIST the bedside team
– Features:
 Real time two way video communication
– Camera, microphone, and video monitor screen in every room
 Real time monitoring of lab data, medications, nursing flowsheets
 Access to imaging studies
 Near real time data and waveforms from each bedside monitor
 Smart Alerts™ and advanced trending
 eCare Manager™, an electronic medical record for ICU

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Why eICU?
• Critical care consumes 1% of the GNP
annually
• ICU’s with 24 hr physician coverage have
shown a reduction in mortality by
approximately 25%
• To fully staff all the ICU’s in the US, 30,000
intensivists would be needed. Presently
there are approximately 6,000.

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Why VISICU?
• VISICU is in over 60 hospital systems with
monitoring ICU’s in over 400 hospitals
nationwide
– Overall mortality reduction: 25%
– Overall LOS reduction: 30%

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How does it work?
• Bedside
– Equipment
 Camera in every monitored room
 Video monitor
 Microphone
 eICU access (Panic) button
 eCare Manager/The Source keyboard & monitor
 Mobile carts
• Central monitoring station (COR)
– Staffing
– Equipment
– Limitations
– Levels of monitoring
– Physician Interventions

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INTENSIVIEW Monitoring Area

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INTENSIVIEW Monitor of
Patients Room

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Staffing
• Central monitoring station
– Staffed around the clock by experienced ICU nurses at
a ratio of 1 nurse per 30 monitored beds
– Physician coverage from 7PM-7AM nights, weekends,
holidays at a ratio of 1 physician per 100 monitored
beds
– Physician coverage around the clock on weekends and
holidays
• Hospital staff privileges
– Each intensivist will be a member of the local hospital
staff

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Equipment
• Monitors - 6
– eCare Manager (2)
 Care plan, quick summary, lab, flow sheets, order &
note writing
 Remote camera operation
– Waveform monitor
– Trending monitor
– PACS System access for images
– The Source

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Limitations
• eICU can’t touch the patient or do physical
exams
– Procedures must be done by the physician at
bedside

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Levels of Monitoring
• Two Categories – picked by the local physician
– Both categories: In the absence of the bedside
physician, the eICU physician will handle life
threatening emergencies including cardiac arrest,
hypotension, shock, acute respiratory failure until a
physician is available at bedside
– Category I
 When any other urgent situation arises, the patient’s
physician will be notified by the eICU physician.
– Category II
 In the absence of a bedside physician, the eICU physician
may order additional tests, change ventilator orders, IV
fluids, antibiotics, electrolyte solutions, sedatives,
analgesics, etc.

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Physician Interventions
• Arrhythmias
• Ventilator changes/Oxygen therapy
• Spontaneous breathing trials
• Fluid and electrolyte replacement
• Confirmation of line & tube placement
• Blood administration
• Talk to patients and families
• Critical values

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eICU: What is it not?
• It is not BIG BROTHER
– No video or audio is ever recorded
– The eICU never monitors a bed without the knowledge
of the personnel in the room
– The eICU does not visually monitor every bed all the
time
 Three situations where a bed is monitored:
– The eICU nurse is evaluating the patient
– The eICU detects an urgent or life threatening problem
– The bedside personnel press the eCare Access (Panic) button
• The eICU is there to ASSIST the bedside team,
not to take over the care of the patient
– The eICU will ALWAYS defer to the bedside team

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Advantages
• Patients
– Decreased mortality
– Potential for earlier diagnosis with advanced trending
and smart alerts
– Less downtime
– Decreased LOS
 Cost
 Morbidity
– It costs the patient NOTHING for this service
 There are no billing codes for the eICU
 Startup costs and first year’s monitoring provided by a
grant from Delta Health Alliance (DHA)

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Advantages II
• Physicians
– Fewer (if any) routine phone calls at night & on
weekends – you’ll be fresher in the morning
– Experienced intensivist is a phone call or a press of
the eCare access (Panic) button away
– If you have specific worries or want something
specific done to your patient(s), let the eICU know
– Notes by the eICU physician are instantly available on
eCare Manager or printouts
– If you do get called out at night, at least it will be for
something billable
– Better documentation for Physicians (legal medical)

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Advantages III
• Nurses
– Nurse to nurse communication
 Troubleshooting equipment problems
 eICU can watch patients for the nurses when they are
away from the bedside
 Nurses can ask experienced nurses in the eICU for advice
 eICU can make the call to MORA
 eICU can run down lab work, imaging results while the
nurse stays at bedside
– Nurse to physician communication
 If the nurse is contemplating calling the bedside physician,
the nurse can talk to the eICU physician
 For Category II, the nurse can get the necessary orders
from the eICU physician

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Advantages IV
• Hospital administration
– Decreased mortality
– Decreased LOS
 Cost savings
– Institution of best practices
 DVT prophylaxis
 Ventilator bundles
– Decreased VAP
 Compliance with Joint Commission mandates
– Better Medical documentation (DRG)

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Unintended Consequences
• Physician buy-in is extremely important. The
more the physicians use the system, the
better the results
• After using the system for a period of time,
hospitals tend to take care of “sicker”
patients on their on rather than transporting
them
• Nurse retention improves

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Summary
• Mississippi will never have enough intensivists, the
eICU extends the ones we have. eICU appears ideal
for Mississippians
• Physicians get more rest and are relieved of
“routine” calls in the middle of the night
• Nurses get to spend more time nursing
• Most importantly, however, the patients are the
ones who stand to benefit the most
• Community also potentially can benefit when
attempting to recruit (Physicians, Nurses, Business)

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 Anatomy of eCareMobile
Camera & Microphone
Battery Power
Monitor
WLAN Antennae
(Wireless only) eLert Button

2-Way Video Screen

Laptop Screen
Speaker (not visible)
Keyboard & Mouse
Retractable Network
Cable for Wired
Version (hidden)

Retractable Power
Cord (hidden) 25

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