eICU® Program Is Significant Addition in
Care of the Critically Ill
This article originally appeared in Pathways, a magazine
published for physicians and the community by UMass Memorial Medical
"The doctor will see you now" has new meaning in this digital age, especially
at UMass Memorial Medical Center where physicians are "seeing" critical care
patients as never before.
In this new medical environment a bandwidth is as important as a bandage, and
a patient's medical history, imaging scans, medical orders and physician notes
are now accessible through technology that delivers real-time bedside
In 2001, the Institute of Medicine sounded an alarm regarding the need for
hospitals to jump on the technology bandwagon. In Crossing the Quality
Chasm, the Institute predicted the coming of automated systems to reduce
errors, and observed that sizable capital investments and multi-year commitments
to build systems would be needed. It called for a nationwide effort to create an
information infrastructure to support the way health care is delivered in the
UMass Memorial indeed heeded that call. The opening of the Intensive Care
Unit in the UMass Memorial Lakeside Wing ushers in an era of technological
innovation, improving the way care is delivered to the critically ill. The ICU
features private rooms for 16 patients, including those recovering from cardiac
surgery. Hidden within the walls of the impressive facility are hundreds of
miles of cables to support the high-tech equipment that provides instant
on-demand access to an impressive menu of digital patient images and
The Lakeside Wing opening paved the way for UMass Memorial to join an elite
list of leading hospitals nationwide deploying significant technological
investments. From early warning software in the ICU to accessing the retrieval
of digital imaging, improvements in efficient technology translate into enhanced
patient safety and greater cost-effectiveness.
|Inside the eICU Command Center, Richard Irwin, MD,
(left) and Craig Lilly, MD, confer on the diagnostic images on an intensive care
ICU patients on both the
University and Memorial Campuses now benefit from the implementation of a
significant advancement in patient monitoring - the e
Program, a virtual intensive care unit equipped with early warning software and
remote digital monitoring providing the data needed to proactively care for ICU
patients. Also participating in the launch of the e
ICU Program are
three UMass Memorial community hospitals: HealthAlliance Hospital in Leominster,
Marlborough Hospital and Wing Memorial in Palmer.
In this critical care environment, trained specialists using software
monitoring protocols provide real-time patient information and evidence-based
decision support. High-resolution video technology allows for virtual rounds to
conduct examinations while the vital ICU nurse and the physician "intensivist"
consult in real-time.
Stationed in a high-tech support center situated on the Hahnemann Campus and
surrounded by computer terminals and video screens, an on-duty eICU
team may suddenly receive an alert that an ICU patient on the University Campus
is experiencing elevated blood pressure and heart rate. The intensivist
immediately alerts the ICU bedside nurse, who can instantly evaluate and
stabilize the situation, and defer what could have been a serious turn in a
Intensivists, who by education and training are board certified by the
American Boards of Anesthesiology, Internal Medicine, Pediatrics and Surgery,
are also certified in the subspecialty of critical care medicine. Studies
estimate that 53,000 to 175,000 deaths per year can be avoided by staffing the
nation's ICUs with intensivists, yet with only 6,000 dedicated intensivists
currently in practice, just 13 percent of all ICU patients receive dedicated
care. Experts believe the severe shortage will only worsen as the population
ages, a problem clearly being addressed at UMass Memorial.
"ICU patients require around-the-clock specialized care. However, most ICUs
lack the specially trained intensivists on staff to provide this level of care.
Through a significant investment in technology and trained personnel, UMass
Memorial becomes the only hospital in Massachusetts to provide such a giant leap
in patient attention and care through its eICU Program," said Richard
Irwin, MD, chair, Critical Care Operations Committee.
"Incredibly, the system allows the eICU experts to help the bedside
providers monitor the patients and detect evolving deterioration before the
patient becomes unstable. This supplemental attention places UMass Memorial
critical care ahead of institutions using older technology," said Craig Lilly,
MD, medical director, eICU Program.
Recent studies show this type of care model can reduce ICU mortality by 25
percent and save costs. The keys are constant surveillance, provision of
immediate physician access to the patient and instant availability to the
patient information needed to make the right decisions as quickly as
"The Memorial Campus intensive care units will be the first to implement the
eICU technology. I am proud of our staff who have worked hard to ensure
that this system benefits our patients," said Peter Bagley, MD, director,
Memorial Campus Critical Care Unit.
"With our new eICU support center linked via telemedicine and
computer monitors to the ICUs, we have the means to monitor and care for
hundreds of patients. The installed system means ICU caregivers at participating
hospital sites will be instantly informed of any changes on a patient's health
in the ICU. As a result, the ICU staff will know the appropriate moment to
intervene and correct small problems before they become more significant," added
Advancements in digital imaging technology also make possible a high-speed
network and picture archiving and communication system (PACS) to improve access
to high quality radiology coverage. Specifically, the computerized network
allows digitalized radiology images to be sent along a secure connection to such
sources as the operating room as well as the critical care postoperative
"Implementing PACS is a challenging project that involves significant time,
effort and special attention to many details," said Dr. Irwin. "Integration,
archive setup, enterprise-wide deployment and IT support are just a few of the
concerns. Certain areas, such as the ICU, require its own particular
PACS and its integration into the intensive care setting involves
"mission-critical" systems that require contingency planning, backups systems
and adequate development to address temporary glitches in hardware, software or
network problems. Although the primary purpose of a PACS workstation is to
display medical images, other beneficial and convenient applications can be
loaded and accessed, such as electronic medical records and e-mail.
Consensus among health care IT developers is that PACS is well on the way for
integration and is interoperable with other key clinical systems. An integrated
PACS will allow further sharing of data, voice and images among colleagues.
"It all boils down to a significant improvement in the quality of care," Dr.
Irwin added. "When you can provide relevant medical information more quickly,
patient care will improve."