Melrose Free Press

March 1, 2012

By Jessica Sacco

Patients in the intensive care unit (ICU) at Melrose-Wakefield Hospital received a little more than candy this Valentine’s Day.

On Feb. 14, Hallmark Health System finalized its electronic ICU (eICU) system, making Melrose-Wakefield Hospital one of only 10 hospitals in Massachusetts to offer the service.

Through a partnership with UMass Memorial Health Care in Worcester, Hallmark Health brought the advanced critical care software program to Melrose-Wakefield Hospital (MWH), which provides physicians and nurses with a constant feed of data on ICU patients.

This allows for round-the-clock monitoring on patients’ blood pressure, oxygen saturation, heart rate, test results, nursing notes and other important information over secure transmission lines.
The technology also supplies a method of consultation between the two hospitals and an extra level of expert care for MWH’s most critical patients.

“We’re really proud of being one of the first community hospitals to be able to offer this,” said Nancy Gaden, assistant vice president for patient care services and chief nursing officer for HHS. “We think this is really fantastic for our community.”

Each of the seven ICU rooms at Melrose-Wakefield Hospital is equipped with a two-way video monitor that connects to the command center at the UMass Memorial Health Care System.
UMass physicians, as well as nurses specially trained in ICU medicine, are able to observe the Melrose patients electronically through voice, data and video monitoring 24 hours a day, seven days a week.

Individuals admitted to the intensive care unit at MWH will still have an attending physician who writes orders, reviews labs, develops a plan of care and is available for questions.

However, Gaden said, if a patient’s doctor is not on hand during the day or has gone home for the night, someone can be available at the Worcester center in a matter of minutes.

The physician who answers will be able to immediately assist the MWH patient, as all ICU doctors at UMass will have each individual’s information readily available.

“There is a verbal handoff to UMass physicians saying what the plan of care would be overnight for the patient or during the day,” said registered nurse Kellie Smith, director of critical care and Medical 3 at MWH.

Family members are also welcome and able to use the system if they have any questions or concerns they need addressed. A monitor is set up in the ICU family waiting room for those who wish to speak with a doctor outside of their loved one’s room.

“If nurses … patients, doctors, family members have a question, or lab results change, they can connect with eICU doctors [in Worcester] all the time and they can make quick decisions,” said Gaden. “The eICU provides a second level of safety and also allows the attending physician [at MWH] to sign off to an ICU doctor [at UMass Memorial Health Care].”

Along with having constant care for ICU patients, whether from MWH staff or through the Worcester center, eICU’s critical care software system can pick up a change in a patient’s status 15 minutes before it would be noticeable to nurses or doctors.

“It’s very sophisticated in terms of being able to predict patient changes before they happen,” said Gaden. “That, in and of itself, is probably the most phenomenal part of the system.”

The system is based on certain algorithms that are designed to detect small differences in lab data or physiological functions (heart rate, blood pressure, respiratory rate, etc).

When a patient’s condition indicates immediate attention is needed, Gaden said yellow alarms alert doctors that action needs to be taken.

“Physicians can immediately respond to prevent a problem for the patient,” she said.

Those who are treated using the eICU system will face no additional cost for the services and although funding for the program comes out of the hospital’s budget, Gaden said it is not as expensive as some may think.

“It’s a modest amount of money,” she said. “Everyone thinks it’s expensive, but it’s not as expensive as adding a physician, and we’d have to add more than one if we wanted to have 24-hour care for all our [ICU] patients.”

Gaden said that using eICU may also save money for community hospitals in general, as patients will not have to be transferred from their local hospital to tertiary hospitals (like Mass. General or Brigham and Women’s) and may have a shortened stay in the ICU.
“In other hospitals with eICU, the savings come from increased revenue and slightly shortened ICU length of stay because you’re able to move through the patient’s plan of care all 24 hours of the day,” she said.

Both Smith and Gaden said families can take comfort in the fact that ICU patients at Melrose-Wakefield Hospital will remain close to home, while still receiving the treatment they need.

“This is better because the family can know that the patient is getting 24-hour expert care … even though they’re still in their own community hospital,” she said.

The eICU system has been running smoothly since Feb. 14. Gaden said that if Melrose-Wakefield Hospital can meet the needs of more and more patients through the program, expanding it could be a possibility in the future.

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