What It's Like Inside an eICU

Patients in intensive care units require around-the-clock care, but with hospitals often filled to the brim and understaffed, it can be difficult. That's where electronic ICUs, also known as eICUs or tele-ICUs, come in. These state-of-the-art telemedicine facilities use video cameras, microphones, alarms and other monitoring tools to keep an eye on the sickest of patients, no matter where they are in the country.

"We are a second set of eyes for taking care of critical care patients," says Lisa-Mae Williams, director of telehealth and eICU at Baptist Health South Florida. "It's like an air traffic control center where patients are the blips on radar, and we're the controllers making sure everything goes smoothly."

When you're in the ICU, a second set of eyes is something you definitely want, says Connie Barden, chief clinical officer of the American Association of Critical-Care Nurses. The remote locations are hooked up to the machines attached to the patient in order keep track of all his or her vital signs, and the room includes a camera. "The camera sits on the wall opposite the bed in the ICU," she says. "When that thing turns on, the tele-ICU nurse can look at the patient's pupils or read a patient's ID band."

But don't worry about privacy -- Barden assures that the cameras are off by default.

Baptist Health South Florida oversees eight hospitals, and its eICU program has 143 beds spread across the facilities. Since its inception in December 2005, Williams says the hospitals have seen success in patient outcomes. "We've seen really great reduction in ICU mortality and length of stay," she says, citing a 49 percent reduction in mortality and 40 percent reduction in length of stay.

A study presented at the American College of Chest Physicians meeting last year found that while eICUs have benefits, they might not be as stark as Williams makes them out to be. Comparing 1,310 patients admitted to traditional ICUs to 1,227 patients admitted to eICUs over a two-year period, the researchers found that 90 patients in the traditional ICU group died, compared to 77 in the eICU group, but the reduction in the length of stay was negligible.

An earlier study, published in the journal Critical Care in 2005, found more of a benefit to eICUs -- patients in the eICU had a mortality rate of 9.4 percent, compared to 12.9 percent in the ICU group, and a length-of-stay of nearly a full day shorter. Besides those two metrics, one of the most important things to look at when evaluating the effectiveness of eICUs is how they improve patient safety. "We documented that the tele-ICU prevented more than 160 falls in a year at just one hospital," Barden says.

eICUs are typically staffed with experienced critical care nurses, who can recognize when one of the patients they are monitoring is moving. "The nurses might see an abnormal signal and flip on the camera to see the patient trying to get out of bed," Barden says. "The tele-ICU nurse can then call up the hospital and have one of the nurses there go check. The nurse sitting 50 or 60 miles away can help keep patients safe."

eICUs remove distance from the health care equation, Barden says, which has consistently been a barrier for hospitals in rural areas. "Some centers monitor hospitals 400 miles away," she says. "And if an area lacks a specialist, patients can have an evaluation through this technology."

The option to have a specialist offer a remote consult can save the patient and the hospital money, Barden says. "When you can bring a specialist to the bed of a patient, they don't have to be moved to a bigger center," she says. "This saves money and keeps the patient with their family."

There are currently 43 eICUs in the country, Williams says, which cover only 13 percent of ICU beds. "There's massive room for growth," she points out.

One thing impeding the growth of these programs is cost. A study published in the Open Medical Informatics Journal last year estimated the setup cost of one eICU program between $2 and $5 million, and then an operation cost of up to $1.5 million annually. "Technology comes with a price tag," Barden says. "In most cases, this is an investment on the part of the hospital into patient safety that most can't afford."

While costs for the patient can range from hundreds to thousands for treatment, it's possible to bring down the cost by encouraging Medicare and other health insurance providers to reimburse for care provided via eICUs, Barden says. "It can be very expensive, and there are only a few, specific instances where this care is reimbursed," she says.

But as technology improves, it will hopefully become cheaper, Barden says, and coupled with adoption by insurance providers, eICUs could become an integral part of health care. "This has the potential to change the way health care gets delivered," she says. "If it can explode and be universally implemented across the country, it could make health care cheaper, more efficient and more effective."

Amir Khan is a Health + Wellness reporter at U.S. News. You can follow him on Twitter, connect with him on LinkedIn or email him at akhan@usnews.com.