Banner telemedicine center backs up ICU staff

Ken Alltucker
http://www.azcentral.com

Patients at Banner Health hospitals may want to take note: the eye in the sky is watching.

Arizona’s largest health-care provider, Banner Health Systems, has installed cameras and monitoring devices that allow doctors and nurses to remotely watch over the most critically ill patients at nine hospitals in Arizona and Colorado.

Welcome to health care, 21st-century style.

“We are there as a second set of eyes and ears,” says Kate Trenary, a former nurse and director of Banner’s remote ICU system.

The telemedicine center, located at Banner’s Desert Medical Center in Mesa, is a back-up system of sorts that aims to help doctors and nurses who are at the hospitals that treat critical patients.

Touted as the first such system used by a hospital in the Southwest, Banner named its remote program iCare ICU.

Within two years, every Banner hospital will be equipped with the cameras and data-transmission equipment that allow doctors and nurses to help take care of patients from afar.

Banner officials say the remote system does not affect staffing levels at hospitals. Rather, its role is to support the hands-on work that hospital doctors and nurses perform. But not everybody is convinced.

The remote center resembles an air-traffic controller’s room more than it does a wing of a hospital.

At the center, nurses and doctors watch over a bank of screens that track patients’ vital signs such as blood pressure or pulse. When the computer screen flicks on with color-coded alerts, the nurses can investigate further by checking the patient’s vital signs, calling the patient’s nurse or doctor at the hospital or turning on the camera and talking to the patient directly. They even have remote access to a patient’s medical records or X-rays.

One factor behind Banner’s decision to sink more than $8 million in the center is to ensure all emergency rooms have access to physicians who are experts in critical care.

Physician shortage creates need

Banner began the remote monitoring system, in part, due to a shortage of critical-care physicians. Not all community hospitals can recruit or hire specialty doctors such as “intensivists” and critical care specialists that improve emergency room care.

Sutter Health operates a similar system in the San Francisco Bay area and Sacramento. Several East Coast hospital groups use the technology, too.

The physician-shortage problem is especially acute during night shifts.

“The need is always greater at night,” says Donna Long, a Banner iCare physician who works the overnight shift. “That is where a hospital’s resources are lacking.”

The iCare center employs specialty physicians from 7 p.m. to 7 a.m. when such doctors are least likely to be on duty at the hospital. The iCare center does not have physicians on duty during the day, but Banner eventually plans to have a physician on duty 24/7.

Long admits that the job of treating a patient remotely can be difficult. One challenge is gaining the trust of the hospital physician who may not know the iCare physician.

“There is always a bit of reluctance to turn you patient over to somebody you don’t even know,” Long said. “You have to prove yourself over time with either phone conversations or direct conversations over the camera.”

Still, Long said the remote physician, who can write orders and advise nurses, can treat a patient before a hospital physician has time to do so. That quick intervention can be the difference between life and death for a patient whose heart has stopped or brain is not functioning.

Saving lives

Physicians such as Long are anxious to quantify the difference the remote center has made in patients lives.

Banner Health offers some measurements of the program’s success.

During the remote system’s first year of operations, participating hospitals treated 6,183 patients and reported mortality rates that were 42 percent better compared with industry standards, according to Banner.

Patients also spent nearly 2,000 fewer days in intensive care than industry standards.

Those figures are based on a hospital industry measurement, called Apache (Acute Physiology and Chronic Health Evaluation), that predicts outcomes of patients under similar circumstances.

“The data shows we have fewer patients dying with Banner,” Trenary says.

Other reports suggest that such remote monitoring systems can save lives and money.

In 2001, Johns Hopkins University study found that linking intensivists to hospitals remotely saved lives, reduced patients’ complications and decreased average length of hospital stays. A 2004 report in Critical Care Medicine also said such systems help save lives and shorten hospital stays.

Other examples are more mundane.

Julie Edwards, a Banner iCare registered nurse, said busy floor nurses routinely request her help monitoring patients.

Edwards also contacts the floor nurse when she notices a patient with low blood pressure or a tangled IV.

Anjee Riecke, a nurse at Banner Gateway Medical Center in Mesa, finds the remote nurses helpful.

“There are times when we have two to three patients as a nurse,” Riecke said. “They have the eyes and ears to watch and listen to our other patients.”

Still, the remote-monitoring program is not without critics.

The California Nurses Association, which advocates minimum nurse-to-patient staffing levels, said that hospitals such as Banner should spend money on nurses and doctors instead of technology. The California Nurses Association backs a bill in the Arizona house that would require minimum nurse staffing ratios for hospitals. Intensive care units would require one nurse for every two patients.

“They should not spend money on technology and spend the money on more registered nurses at the bedside, especially in ICU,” said Malinda Markowitz, president of the California Nurses Association’s national organizing committee. “Nurses have to be there at the bedside to use the smell, the touch the feel that you can’t get remotely.”

Banner representatives stress that the technology does not replace the function of on-site nurses and doctors.

“For nurses and physicians who utilize this, they love it,” Trenary said. “We help them. We help the nurses that can’t physically be in two places at once.”

Reach the reporter at ken.alltucker@arizonarepublic.com or (602)444-8285.

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