New technology allows Cincinnati VA to give care across U.S.

BY THE NUMBERS: Tele-Intensive Care Unit at Cincinnati VA Medical Center

12 hospitals covered by the Tele-ICU based in Cincinnati

5 states being served

19 ICUs included in the program

213 ICU beds monitored 24 hours a day

52,092 camera interactions by Tele-ICU in 2014 in Ohio

$7 million annual budget

Locations:

Source: Cincinnati VA Medical Center

In a modest room on the ninth floor of the Cincinnati VA Medical Center, a team of doctors and nurses are providing care to critically-injured veterans across five states.

The hospital is working to improve and expedite care for the nation’s veterans through more than 60 computer monitors, high-resolution cameras and the real-time sharing of hundreds of electronic medical records every day.

Cincinnati's Tele-Intensive Care Unit opened in early 2012 to monitor 72 ICU beds in Ohio's four VA medical centers, including Dayton and Cleveland. The operation continues to expand, now overseeing 213 ICU beds in states as far south as Georgia and Alabama, said Michael Torok, RN, Tele-ICU operations director.

“We are watching over our veterans,” Torok said. “The VA is a high-tech, government hospital system. This shows the investment the VA puts into its patients.”

The original investment was $4 million by the VA and an annual operating budget of $7 million, according to Torok.

The Tele-ICU is staffed with critical care nurses 24 hours a day, and with physicians board certified in critical care from 4 p.m. to 8 a.m. Monday to Friday and 24 hours a day on weekends. There are 27 full-time equivalent nurses and eight critical care physicians, also called intensivists.

“The ICU is our sickest patients,” Torok said, recovering from a complex surgery or cardiac event, for example.

In Ohio alone, there were over 52,000 uses of the Tele-ICU in 2014, according to Torok. In the first two quarters of this year, the cameras have been used 21,760 times for Ohio veterans.

The operation continues to grow as more hospitals request to join, Torok said. They are currently in negotiations to add another seven hospitals — 100 more ICU beds — in 2016.

To keep up with demand, a Tele-ICU satellite location opened in 2013 in Cleveland and a second satellite will open in October in Greater Los Angeles, according to Torok.

The Tele-ICU itself is also in contract negotiations to relocate its growing operations into a 6,000-square-foot space in the John Weld Peck Federal Building downtown. That move would increase capacity from 10 work stations to 25 work stations.

All the 213 ICU rooms have a red eICU button that when pushed will request a Tele-ICU nurse or physician. After ringing a virtual doorbell, the Tele-ICU worker appears on a flat screen TV and uses their mouse to move the room’s camera around to communicate with the patient and on-site medical workers.

Torok said, for example, if an injured veteran is admitted to an ICU at 2 a.m. on a Sunday, the Tele-ICU is an immediate way to have qualified critical care staff on hand to troubleshoot the patient’s problems during those off and late hours.

Inside the Tele-ICU in Cincinnati, each work station consists of six computer screens to monitor the patient’s vitals, receive calls, read lab results and submit work orders, among other things, said Alex Geimeier, a critical care registered nurse in the unit.

“We don’t take the place of any nurse or doctor by the bedside,” Geimeier said. “We monitor and oversee and call the nurse into the room if (the patient) gets worse.”

Geimeier said while an ICU nurse might manage two patients, a Tele-ICU nurse can manage up to 40 patients — and the physicians about 150 patients.

To help effectively manage all those patients, an electronic medical program “scores” patients as either low, medium or high. That determines how often the Tele-ICU nurse checks on the patient beyond routine checks, Geimeier said.

If a patient scores high they are checked every two hours, while those scored as low risk are checked every eight hours. Patients are also color coordinated on whether their status is improving or declining.

Geimeier said the electronic system constantly updates to reflect a patient’s changing vital signs, new lab results or X-rays, and six body systems — respiratory, hematology (blood count), cardiovascular, infectious disease, renal (kidneys) and central nervous system.

“Nurses are tasked with more and more; we can help check medications, read lab reports, make phone calls to keep them at the bedside,” Geimeier said.

Torok said the Tele-ICU staff is credentialed to be able to immediately start treating a patient that is quickly deteriorating while the on-site staff is responding.

On weekends at the Chillicothe VA Medical Center, the medical staff is reduced to just two physicians for the entire hospital, said Angie Thomas, nurse manager in the Chillicothe ICU. She said their ICU calls on the Tele-ICU for help at least once a day.

“It’s an extra set of eyes for patients,” Thomas said, in an interview through the Tele-ICU monitors. “Having the Tele-ICU here, we hit the button and have a doctor here in the evenings.”

Torok said a Tele-ICU is one solution to “spread out the expertise over a large area,” in the midst of physician and nurse shortages in critical care.

“VA hospitals are seeking us out,” Torok said. “We started out small but VAs are looking for ways to supplement coverage.”