{"id":14078,"date":"2018-01-08T09:53:19","date_gmt":"2018-01-08T16:53:19","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=14078"},"modified":"2024-12-16T14:46:47","modified_gmt":"2024-12-16T21:46:47","slug":"virtual-health-adds-another-level-of-safety-benefitting-patients","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/virtual-health-adds-another-level-of-safety-benefitting-patients\/","title":{"rendered":"Virtual Health adds another level of safety, benefitting patients"},"content":{"rendered":"
<\/div>
\"A
Jen Dessauer, a critical care nurse in UCHealth’s Virtual Intensive Care Unit, in front of a bank of monitors she uses to help keep patients in the ICU at UCHealth Longs Peak Hospital safe. The top middle monitor shows a patient room (empty to protect privacy). The other monitors display patients’ vital signs and assessments of the severity of their conditions.<\/figcaption><\/figure>\n

A suite tucked into a corner of an ordinary-looking building in Aurora is the unlikely home of an intensive care unit.<\/p>\n

There are no beds, IV lines, syringes, pumps or tubes. There are no hospital rooms. There aren\u2019t even any patients \u2013 at least at first glance.<\/p>\n

But in fact, the patients are there \u2013 not in the flesh but rather on the screens of large computer monitors that occupy much of the suite\u2019s open space. They are 30-some miles away, at the six-bed ICU at UCHealth Longs Peak Hospital<\/a> in Longmont and a few miles north at the nine-bed Burn\/Trauma ICU at UCHealth University of Colorado Hospital<\/a>.<\/p>\n

Welcome to UCHealth\u2019s Virtual ICU. It is part of the Virtual Health Center, a project launched earlier this year to give direct-care providers on the ground help from afar in keeping tabs on patients. In the Virtual ICU (VICU), that involves experienced critical-care nurses who monitor patients on camera for tell-tale signs of declining health. They keep an eye on their vital signs and look for adverse trends or acute changes, using electronic tools that assess the severity of their condition, said Frank Newsome, registered nurse and director of patient services for the Virtual Health Center.<\/p>\n

A VICU nurse who sees a problem crop up \u2013 a sudden drop in blood pressure, for example \u2013 while a patient\u2019s bedside nurse is in another room or occupied with a task, can quickly call attention to it, potentially saving precious response time. If the problem is serious enough, physicians in the VICU can direct treatment in real time, Newsome said.<\/p>\n

Extra pairs of eyes<\/h2>\n

The fundamental goal is to improve patient care while making the most efficient use of resources, said Dr. Benjamin Scott<\/a>, medical director for the Virtual Health Center.<\/p>\n

\u201cIt\u2019s a layer of surveillance support for nurses, residents and attending physicians, and a layer of safety for patients to make sure that any deterioration they have is recognized and addressed as rapidly as possible,\u201d Scott said.<\/p>\n

In addition, Scott said, the VICU assists the bedside team by providing \u201ccontinuous clinical evaluation\u201d of patients in real time. That includes looking for signs of agitation, checking Alaris medication pumps, reviewing orders, and ensuring proper delivery of oxygen to patients on ventilators, to name a few.<\/p>\n

The idea of the VICU is to put extra eyes on patients, not to look over the shoulder of providers at the hospitals \u2013 the \u201cbig brother phenomenon,\u201d as Scott put it.<\/p>\n

\u201cThe VICU nurses are looking for patterns with the patients,\u201d he said. \u201cIt can be helpful to have someone doing that who is not caught up with bedside activity.\u201d Providers can benefit from having access to an intensivist away from the site who can \u201cthink more slowly and come up with suggestions for care,\u201d he said.<\/p>\n

\u201cWe\u2019re all working toward the same goal,\u201d said RN Brett Fisher, nurse manager for the Virtual Health Center. \u201cEvery nurse wants better patient care and we\u2019re here to help with that.\u201d<\/p>\n

Fisher, who joined UCH four years ago and worked in the Medical Intensive Care Unit, said he was attracted to the Virtual Health Center\u2019s \u201cintersection of data analysis and nursing\u201d \u2013 the place where providers use technology to complement their clinical skills and improve patient outcomes.<\/p>\n

Humans and machines unite<\/h2>\n

On a November afternoon, Jen Dessauer, RN, stood at that intersection. Dessauer, who joined UCHealth last January, puts her nearly 15 years of nursing experience \u2013 10 in critical care \u2013 to use in the VICU. On this day, she watched a bank of six large computer monitors, one showing an ICU patient at Longs Peak, others displaying blood pressure, pulse rate, oxygen levels and other vital signs for each patient in the unit. Dessauer could also see at a glance the severity of each patient\u2019s condition \u2013 red indicating the most concerning, green the least, and yellow in the middle. She was 30 miles away but intimately involved in their care.<\/p>\n

\u201cOn the clinical side, it\u2019s the same as being a bedside nurse,\u201d she said. \u201cYou get to know the patients,\u201d adding that she makes virtual safety rounds on those with the highest severity scores every hour.<\/p>\n

\u201cIt\u2019s a little like being an air traffic controller,\u201d Newsome said. \u201cWe\u2019re looking for adverse trends,\u201d such as plunging blood pressure, sudden changes in heart rate, signs of respiratory distress and gradual signs of decompensation that may be difficult to detect.<\/p>\n

\u201cThis is not replacing the bedside nurses,\u201d he added. \u201cRather, we are adding a member to the care team.\u201d<\/p>\n

\"A
Kenyetta Maloid, CNA, in the Virtual Health Center. Maloid uses Safety View to monitor patients in UCHealth hospitals who are confused or are at risk for falling, pulling out medication lines or other concerns.<\/figcaption><\/figure>\n

Dessauer said she keeps a close eye on each patient\u2019s numbers, but she also relies on high-definition images from the cameras trained on the patients. For example, she said, signs of skin tightening around a breathing tube could trigger a call to consider repositioning the tube.<\/p>\n

Team building across the miles<\/h2>\n

RN Joe Gerardi, chief nursing officer for Longs Peak Hospital, said the hospital and the Virtual Health Center use \u201crelationship building\u201d to build collaboration among care givers. For example, Longs Peak nurses visit the VICU to meet their counterparts, and the two teams have \u201congoing dialogue\u201d about monitoring procedures and review cases that resulted in the VICU making calls. The VICU nurses also participate remotely in bedside rounds at the hospital to familiarize themselves with the patients they\u2019ll be watching.<\/p>\n

Debbie Voyles, UCHealth\u2019s director of Virtual Health, said collaboration between providers is essential to UCHealth\u2019s \u201cstrategic plan\u2019\u2019 for delivering a variety of telehealth services. That means, for example, keeping the operation home-grown: no outsourcing to third-party \u201cdocs-on-call\u201d services.<\/p>\n

\u201cWe made a decision to use our own providers and our own medical records,\u201d Voyles said. She noted that all virtual health services \u2013 workflows, schedules, documentation, and so on \u2013 are embedded in the Epic electronic health record, ensuring that every virtual health provider sees a complete medical chart and has the resources necessary to deliver the same level of care as a provider in the hospital or exam room.<\/p>\n

\u201cThe idea is that a telehealth visit through UCHealth is equivalent to a face-to-face visit,\u201d Voyles said.<\/p>\n

Tele-growth<\/h2>\n

The Virtual Health Center is only one part of UCHealth\u2019s burgeoning Virtual Health program<\/a>. It provides telestroke services to more than a dozen hospitals both in and out of the system, while a growing number of ambulatory clinics offer patients remote visits with providers. Patients also can schedule Virtual Urgent Care visits for selected non-emergency conditions through My Health Connection<\/a>, the Epic patient portal.<\/p>\n

In addition to the VICU, the Virtual Health Center handles telemetry monitoring for cardiac patients and provides \u201cSafety View,\u201d which is a remote or \u201cvirtual sitter\u201d program for monitoring of patients who are confused or have safety needs such as preventing them from falling or removing necessary medical lines or tubes.<\/p>\n

Safety View is live at Longs Peak Hospital, UCHealth Memorial Hospital North and Memorial Hospital Central in Colorado Springs, and at Poudre Valley Hospital and Medical Center of the Rockies in northern Colorado. University of Colorado Hospital in metro Denver is slated to go live in January 2018, Voyles said.<\/p>\n

It all requires a significant financial commitment. Voyles said UCHealth invested about $1 million in the Virtual Health Center alone. Work that began in January 2017 included hardwiring the suite, installing a generator to ensure 24-hour patient coverage, purchasing equipment, remodeling, and providing adequate staffing.\"An<\/p>\n

\u201cWe built the space from scratch,\u201d said Newsome, who credited collaboration between providers and the Facilities, Biomed, IT, and Epic teams for the success.<\/p>\n

Wide-ranging need<\/h2>\n

The completed build-out puts UCHealth and the Virtual Health Center in position to meet the challenges of delivering medical care in the 21st<\/sup> century, Newsome said. He noted that the Virtual Health Center will likely serve new UCHealth hospitals in Highlands Ranch and Greeley, but he doesn\u2019t see the growth stopping there. A national shortage of intensivists, for example, promises to increase the importance of services like the VICU, particularly in hospitals serving rural communities.<\/p>\n

\u201cThis is the future of medicine,\u201d Newsome said. \u201cTelehealth extends our reach to smaller community hospitals.\u201d<\/p>\n

Scott saw the benefits of telehealth during his residency and fellowship at the University of Pennsylvania, which he said was one of the first medical centers to implement the concept. Penn wired its surgical intensive care unit with cameras and microphones, installed round-the-clock nursing coverage, and provided a telemedicine intensivist to support the bedside ICU team, Scott said.<\/p>\n

He experienced the system as a physician monitoring patients and working with bedside staff to deliver the best possible care. Doing that, he realized how \u201ca second pair of eyes\u201d could ease pressure on staff in a large academic medical center caring for growing volumes of acutely ill patients. He said virtual health services can help providers in Colorado meet another kind of challenge: caring for patients who might be a couple of hundred miles or more away from an intensive care specialist.<\/p>\n

\u201cWe have a very large catchment area at UCHealth,\u201d he said. \u201cWhen I came here, I had a strong sense that we could use telehealth to benefit our patients.\u201d<\/p>\n

\"A
Members of the Telemetry team in the Virtual Health Center monitor UCHealth patients who wear equipment to track their heart rate, breathing and other vital signs.<\/figcaption><\/figure>\n

Demonstrating that benefit is an important part of Newsome\u2019s job. He documents all interventions that VICU nurses initiate based on their observations.<\/p>\n

It\u2019s early days, but Gerardi said the system is working well. \u201cWe\u2019ve had early interventions initiated by the VICU, where they have called in on something like a change in blood pressure and alerted the nurse here to go to the bedside,\u201d he said. \u201cWe know we have eyes on our patients at all times.\u201d<\/p>\n

Scott said that in addition to documenting interventions and saves, the team has a \u201cmore ambitious\u201d data collection plan in development. That effort would document core quality measures, including fall rates, central line infections, hospital-acquired infections, length of stay, and ventilator use among all patients monitored.<\/p>\n

The VICU will ultimately be judged on its performance, just as all other programs are, Voyles said. But she sounds an optimistic note.<\/p>\n

\u201cCost will be one measure we use to evaluate it,\u201d she said. \u201cWe will do more evaluations with Longs Peak and the Burn\/Trauma ICU to see if we have identified interventions sooner and to see if we\u2019ve made a difference in patient safety. We\u2019ll figure out the costs and the benefits. We\u2019ve started small, but I don\u2019t think that will be for very long.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

A suite tucked into a corner of an ordinary-looking building in Aurora is the unlikely home of an intensive care unit. There are no beds, IV lines, syringes, pumps or tubes. There are no hospital rooms. There aren\u2019t even any patients \u2013 at least at first glance. But in fact, the patients are there \u2013 […]<\/p>\n","protected":false},"author":2143,"featured_media":14087,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[267,315,3405],"class_list":["post-14078","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-intensive-care-unit","tag-uchealth-longs-peak-hospital","tag-virtual-health"],"acf":[],"yoast_head":"\nVirtual ICU adds another level of safety - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Virtual ICU adds another layer of safety for patients and promises to be the wave of the future in modern medicine.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/virtual-health-adds-another-level-of-safety-benefitting-patients\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Virtual Health adds another level of safety, benefitting patients\" \/>\n<meta property=\"og:description\" content=\"Virtual ICU adds another layer of safety for patients and promises to be the wave of the future in modern medicine.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.uchealth.org\/today\/virtual-health-adds-another-level-of-safety-benefitting-patients\/\" \/>\n<meta property=\"og:site_name\" content=\"UCHealth Today\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/uchealthorg\/\" \/>\n<meta property=\"article:published_time\" content=\"2018-01-08T16:53:19+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-12-16T21:46:47+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/01\/08031700\/featurephoto.jpg\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Tyler Smith\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@uchealth\" \/>\n<meta name=\"twitter:site\" content=\"@uchealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Tyler Smith\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/virtual-health-adds-another-level-of-safety-benefitting-patients\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/virtual-health-adds-another-level-of-safety-benefitting-patients\\\/\"},\"author\":{\"name\":\"Tyler Smith\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#\\\/schema\\\/person\\\/98c85c0e40c4933eedcec2cd054f349d\"},\"headline\":\"Virtual Health adds another level of safety, benefitting patients\",\"datePublished\":\"2018-01-08T16:53:19+00:00\",\"dateModified\":\"2024-12-16T21:46:47+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/virtual-health-adds-another-level-of-safety-benefitting-patients\\\/\"},\"wordCount\":1885,\"publisher\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/virtual-health-adds-another-level-of-safety-benefitting-patients\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/uchealth-wp-uploads.s3.amazonaws.com\\\/wp-content\\\/uploads\\\/sites\\\/6\\\/2018\\\/01\\\/08031700\\\/featurephoto.webp\",\"keywords\":[\"Intensive care unit\",\"UCHealth Longs Peak Hospital\",\"virtual health\"],\"articleSection\":[\"Innovative care\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/virtual-health-adds-another-level-of-safety-benefitting-patients\\\/\",\"url\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/virtual-health-adds-another-level-of-safety-benefitting-patients\\\/\",\"name\":\"Virtual ICU adds another level of safety - 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