Healthcare executive leaders are faced with an ongoing nationwide shortage of critical care physicians and nurses, otherwise known as intensivist clinicians, and many healthcare leaders project that the workforce gap will only intensify as acuity of illness, complexity of care and healthcare costs continue to rise.
With an increase in the number of critically ill patients, the challenge of meeting this need for comprehensive critical care medicine is being felt at Atlanta-based Emory Healthcare as it is as most major hospitals and health systems across the country.
“The environment in which critical care is delivered is highly technical, IT-rich, and the people who deliver critical care, that would be intensivists physicians and critical care nurses, and also allied health personnel, such as respiratory therapists, critical care pharmacists, nutrition support specialists, they all have had much additional training and are technically very advanced,” Timothy Buchman, Ph.D., M.D., founding director of the Emory Critical Care Center, says.
However, there are a number of forces at work creating challenges for critical care, Buchman notes. “We are running out of experienced professionals. The experienced critical care nurse at the bedside is no longer 30 or 40 years old, and many are now approaching retirement age as are the physicians,” he says. “To make matters worse, those experienced people are mal-distributed and tend to congregate in major cities and it leaves the smaller hospitals in suburban and rural areas relatively thin on that level of experience. If you go 50 miles outside of Atlanta, there are plenty of hospitals that have ICUs, but zero to one ICU physician and the majority of the nurses who work in the ICU may not have specialist critical care training.”
Healthcare leaders at Emory Healthcare, the largest health system in Georgia with six hospitals and 16,000 employees, launched its eICU Center in March 2013 at Emory University Hospital to provide round-the-clock ICU monitoring, and the eICU service has since expanded to all hospitals in the health system. Seeing the success of tele-ICU technology, Cheryl Hiddleson, MSN, R.N., director of the Emory eICU Center and Buchman decided to take this program a step further, about 9,000 miles further. This past July, Emory Healthcare, through its Emory eICU Center, collaborated with Sydney-based Macquarie University’s MQ Health program and technology vendor Philips to roll out a project that delivers remote intensive care services from critical care specialists stationed in Sydney, Australia.
Timothy Buchman, M.D., and Cheryl Hiddleson, R.N.
Referred to as the “Turning Night into Day” program, it’s a three-way partnership using remote monitoring to bring 24/7 eICU care to Emory Healthcare patients in Atlanta. Emory Healthcare critical care physicians and nurses based at workstations at Macquarie University’s MQ Health in Sydney use Philips’ eICU technology to provide additional patient monitoring in the ICU.
The pilot program aims to improve the outcomes of high-risk patients in greatest need of constant observation. Combining daytime critical care coverage in Atlanta with night-time coverage from Sydney provides focused, 24-hour-a-day management of ICU patients by critical care specialists, potentially decreasing the risk of complications and shortening patients’ length of stay, according to Buchman.
By using providers in a complementary time zone –– in this case, Sydney –– to cover the Atlanta eICU night shift, it reverses two of the largest drawbacks of critical care night staffing: a shortage of senior clinicians willing to cover night shifts, and the toll that working nights takes on caretakers and their attention levels, Buchman and Hiddleson contend.
“The senior nurses prefer weekday day shifts. You’re just not as sharp at 3 a.m. as you are at 3 p.m. And at nighttime, it’s usually the newest graduates, the least experienced nurses, the ones who need the most guidance and mentorship,” Buchman says.
He adds, “In any healthcare organization, the most valuable resource that we have is our people. If you look at the medical specialties that are out there, the top of the burnout list is critical care. So, we believe that the efforts we’re making in improving the work-life balance and work-life integration of our caregivers will pay the greatest dividends for our patients.”
Citing the success of Emory Healthcare’s eICU Center, Buchman says, “At one point, we said, ‘What if we were to take our entire eICU operation, the hardware, software, the physical environment, and create a copy of it in Sydney Australia, and then rotate for a period of six to nine weeks, a physician and a nurse down to Sydney, and literally allow them to turn night into day, to deliver care back into the Georgia nighttime from the Sydney daytime?,” Buchman says.
The program is set up to have one physician and one nurse working remotely from the Sydney workstations three or four days a week and working concurrently with two nurses on staff in the ICU in the Atlanta hospitals.
“Thanks to our eICU program we can continuously monitor Atlanta-based patients from MQ Health in Sydney and support the bedside team by recognizing adverse physiology, making critical diagnoses and intervening before those issues become significant problems,” Hiddleson says.
According to Buchman, the cross-global remote monitoring program enables healthcare providers to deliver care to critically ill patients that is more timely as well as more effective, accurate and precise.
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