Starting next month, intensive-care patients at Inova Alexandria Hospital will be monitored round-the-clock by more than doctors and nurses at their bedsides. Digital cameras, microphones and special software will link patients and their caregivers to a team of intensive-care specialists who also will monitor their care -- from miles away.
The hospital's new intensive-care system is the first in the Inova Health System's multimillion-dollar project to bring a "virtual ICU" to as many as 200 critically ill patients in the intensive-care units of its four hospitals in the next year. The systems are a growing trend in the nation's hospitals, which are struggling to improve care in intensive-care units while coping with a severe shortage of intensive-care medical specialists.
Since being introduced two years ago in hospitals in southeastern Virginia, the systems have spread rapidly nationwide.
By the end of the year, more than 100 hospitals will use the "eICU" systems to monitor more than 2,000 intensive-care patients, according to Brian Rosenfeld, an intensive-care doctor who dreamed up the idea for the system while practicing at Johns Hopkins Hospital. Rosenfeld is now chief medical officer at VISICU, the Baltimore company he co-founded to make and market the systems.
When the Inova system is fully operational, seven intensive-care doctors and nurses will staff the system, which will be housed in a Verizon building close to Inova's flagship hospital, Inova Fairfax.
Cameras and microphones installed in each intensive-care room and special computer software will allow those at the remote site to monitor heart rates, blood pressure, respiratory rates and other vital signs of critically ill patients even more intensively than the staff on duty can. The video and audio links will enable the eICU staff to look at the patient and talk to caregivers.
The idea, Rosenfeld said, is to catch problems early, when rapid medical intervention can mean the difference between life and death. He said it also can reduce costs by helping ICU patients get well faster.
About 500,000 Americans die in ICU units each year. But studies have found that the number of deaths in ICU units that used the remote care fell by as much as 50 percent. Length of stay and cost of ICU care dropped by one-third.
But the system has raised concern among some nurses at Inova that the cameras will be used as a Big Brother system to check up on them.
"It casts a shadow over you," one nurse said in an interview this week. She spoke on condition that she not be identified, fearing retribution. "Basically, they're kind of looking at you and saying, 'We don't trust you.' "
But Fairfax officials denied yesterday that the system is designed to check up on nurses. They said the cameras are activated only if the system's patient-monitoring software detects a problem. In that case, the remote team would call the nurses' station and ask permission to activate the cameras.
The cameras also can be activated if an ICU nurse in the room asks for help from the remote team. A bell alerts those in the room that the video system is being turned on, said Elizabeth Raitz Cowboy, a critical-care physician who heads the eICU project at Inova. "The cameras are not randomly turned on," she said.
Cowboy also said the system is not expected to reduce Inova Health System's workforce of 1,000 intensive-care nurses, nor will the hospital reduce ICU staffing because of the system.
"We are part of the care team," Cowboy said. "We are not the primary caretakers."
Justine Medina, director of professional practices and programs at the American Association of Critical-Care Nurses, said nurses have received the systems well when they have been installed in other hospitals around the country.
"It sounds a little creepy at first," Medina said, but she added that the system "does not replace the nurse or any other member of the health care team."