March 30, 2009

A patient at Marlborough Hospital was suffering from severe pneumonia. After she was intubated, her heart rate dropped to a dangerous level. Dr. Craig Lilly was 15 miles away in Worcester, but he was watching the patient and monitoring her vital signs and he quickly walked the medical professionals on the scene through procedures to stabilize her condition.

Lilly described the event hours later in the room where he handled the emergency. It looks a bit like a NASA control room, with work stations surrounded by multiple monitors displaying various lists and charts.

Electronic Age
This is the UMass Memorial eICU. From here, doctors and other medical staff with special training in intensive care medicine watch over the UMass Medical Center's ICUs, as well as those of Marlborough Hospital, HealthAlliance Hospital in Leominster and Wing Memorial Hospital in Palmer, which are all part of the UMass Memorial  system. Lilly said the eICU staff makes 70 to 80 interventions every day, and handles a life-or-death situation once or twice a week.

The eICU opened in 2006, and it has had serious, measurable success improving medical results since then. According to Lilly, the eICU saves 350 lives a year. That's a result not just of interventions in critical moments but also of day-to-day, hour-to-hour monitoring that ensures patients get the tests, medication and support they need.

Each workstation at the eICU holds six to eight flat-screen monitors, which stream in information on patients' vital signs, lab results and transfer and discharge information - all from different database systems. Doctors and other staff watching the monitors can double-check that onsite staff are following best-practice protocols. Before the program began, Lilly said, UMass Memorial had a respectable 80 percent track record for following best practices. Afterwards, it was up to 98 percent or higher.

That translates to savings not just in lives, but also in money. Lilly said the eICU, which cost $8.5 million to build, has reduced the cost of care by 20 percent by helping patients switch to cheaper medications, addressing problems faster and reducing complications.

"Patients that don't get as sick don't stay as long," he said.

UMass Memorial  was one of the first teaching hospital systems to introduce an eICU, which previously was used mostly in rural areas with limited access to intensive care specialists. Lilly said about 400 ICUs in 37 health care systems across the country now use eICUs, but UMass Memorial's remains the only one in Massachusetts.

Not Big Brother
Beyond the technical issues involved in getting the eICU going, Lilly said one of the big challenges of the implementation was helping doctors and nurses understand how the program would work. At first, he said, "a lot of the nighttime nurses thought it was there to snoop on them."

But Lilly said it didn't take long for ICU staff to appreciate the value that the remote staff provides. They can keep an eye on data from many patients at once, without the distractions of running around the floor providing hands-on care, and they have instant access to online resources to help find the most appropriate treatment for unusual conditions that come up. Lilly said it helps that the same intensivists that work in the eICU also spend time on the other side of the cameras in the ICU.

These days, many of the initial kinks of the program have been worked out, but Lilly said the eICU staff members are still striving for even better compliance with best practice standards. They're also looking at the possibility of expanding the eICU to cover children's ICUs, and even creating partnerships to cover ICUs at non-UMass Memorial  hospitals.

At the same time, Lilly said, they have good reason to be proud of what they've achieved so far.

"It's one thing to say you saved 350 lives," he said, "And another to see people out in the community who would otherwise have died of an overwhelming pneumonia."

This article was originally published by Worcester Business Journal.