Technology brings specialist care to remote VA hospitals' ICU units.
Katie McQuillan was a little worried about her patient.
His heart rhythm was abnormal and his magnesium levels too low. She was afraid he might take a sudden -- and possibly fatal -- turn for the worse.
McQuillan, an intensive care nurse, turned to a colleague at the Veterans Affairs Medical Center in Minneapolis. "There might be a nice way to go in the room, tell them he needs two grams of mag," she said.
The only problem: The patient's room was 250 miles away, in Des Moines.
McQuillan, 30, is one of a team of doctors and nurses helping to transform the way the VA cares for patients in its intensive care units by tracking them remotely from a new Tele-ICU center in the Minneapolis hospital.
Ordinarily, nurses have their hands full trying to manage two critically ill patients at once. McQuillan can juggle 35, in six cities, without even leaving her desk. From a bank of computers in Minneapolis, McQuillan can tell if someone in the Iowa City VA is having trouble breathing, someone in Omaha has an irregular heartbeat, or someone in Spokane is going into kidney failure.
It's part of a growing national trend: using "eye in the sky" technology to help guide care at the bedside, sometimes from hundreds of miles away.
"It's a second set of eyes," said Dr. Robert Bonello, the VA project's medical director. The centralized hub can offer highly specialized expertise to even the smallest hospital, he said, and avoid the need to transfer frail patients to get the care they need.
Last summer, the VA became the first hospital in the Twin Cities to start a virtual ICU, which now serves as a hub for seven regional hospitals. In December, the Fairview system launched a similar project at five of its Minnesota hospitals.
"You can't feel their pulse," Bonello said, but "you can see a lot and tell a lot about the patient."
One afternoon last week in Omaha, Dr. Karel Capek entered a patient's room and hit a button on the wall, activating an overhead camera and microphone. For Capek, a surgical resident at the Omaha VA hospital, it's become part of a daily ritual.
"Hey, Karel, how are you?" said Dr. Matthew Goede, an intensive-care specialist in the Minneapolis hub.
Capek, dressed in hospital garb, turned to his patient. "We're going to talk to the doctor in Minneapolis, OK?"
Goede, in a green sweater and khakis, greeted the patient cheerfully. "Hello," he said. "We're the air traffic controllers. We watch from afar."
The virtual ICU is a long way from the sterile real thing. A bottle of Mountain Dew sits on one desk; an open box of Wheat Thins is on the floor. There's freshly ground coffee in the corner, and white coats and stethoscopes are nowhere to be seen.
Goede, 36, faces six computer monitors flashing the vital signs of dozens of patients. With a touch of a button, he can see minute-by-minute patient updates, as well as X-rays, MRIs and anything else in the medical record. With the camera, he can zoom in close enough to see the patient's eyes.
"To me, it really isn't that much different," says Goede. "I still think of these patients as my patients."
The computer will flash an alert if something's amiss; red if urgent, yellow if less so.
Often, the monitoring equipment will see something the bedside staff is simply too busy to notice: a sudden drop in blood pressure, for example. "Some of these small sites, there's only two ICU nurses," McQuillan said. "So if someone is crashing ... who's going to keep an eye on the other patients?"
A perfect fit for the VA
Bonello, the project director, said he heard about the virtual ICU several years ago and thought it was "ideally suited" for the VA system. In many small ICUs, he noted, the staff has little special training in complex cases, such as patients on ventilators or with deadly infections. This way, he said, they get expert advice, and patients can get the care they need closer to home.
At the same time, Bonello was wary of creating a "Big Brother" atmosphere, especially with cameras in the rooms. So they make a point of turning the cameras off, pointed toward the wall, until they're needed. "We're not charging in there and taking over," said Kay Clutter, operations director. "We use our cameras as little as possible."
In December, Fairview opened a virtual ICU at the University hospital to help oversee the care at five smaller hospitals. Already, it has saved some patients from potentially dangerous situations, said Dr. Craig Weinert, the medical director. In one case, a nurse in the "virtual hub" saw from the vital signs that a patient was going into kidney failure, and alerted the bedside nurse to give fluids "right now!" The patient bounced back quickly.
"We intervene as if we were there," Weinert said.
Some bedside nurses might feel threatened by this kind of second-guessing, said Matthew Byrne, an assistant professor of nursing at St. Catherine University in St. Paul. But if it saves lives, he said, "they start to become believers." As a nurse and an academic researcher, he believes this kind of technology could be a great help. Nurses "only have so many eyes and so many hands," he noted.
Already, some studies suggest virtual ICUs may save both lives and money. In Green Bay, Wis., Bellin Memorial Hospital saw a 34 percent drop in the death rate of ICU patients after it started working with a virtual ICU, said Erin Green, of Froedtert Health, which runs the program. From 2007 to 2008, it also cut the number of ICU patient days by 29 percent.
"We catch things; we see things," she said. With closer monitoring, they were able to get patients off ventilators -- and out of intensive care -- more quickly.
"I really think, through this concept, we're really transforming care delivery," she said.
Maura Lerner • 612-673-7384