For eight years, Julie Swann has seen the acuity levels of patients increase in the medical/surgical intensive care unit at St. Joseph's Health System in Atlanta.

"Drugs and procedures are keeping patients alive longer, but when they come to us, they are more fragile and often have multisystem failures. They are the sickest of the sick, but ICU nurses can't be in their patient's rooms constantly," said Swann, RN, BSN.

Photos by BARRY WILLIAMS/Special (ENLARGE)

Julie Swann checks a video feed from a patient's room in the MAXcare eICU remote unit at St. Joseph's Health System in Atlanta.

(ENLARGE)

Julie Swann (background) and Daisy Golden monitor ICU patients from the MAXcare eICU core unit at St. Joseph's Health System.

(ENLARGE)

Along with cameras and headphones, EKG screens help connect the remote center with intensive care units.

Since February 2007, nurses in three of St. Joseph's intensive care units have been getting help from a remote monitoring system called MAXcare eICU. Working from a control center in a doctor's building on the hospital campus, a staff of critical-care nurses, physicians and clerical staff provide backup to bedside ICU nurses.

Nurses and physicians who staff the eICU sit at workstations that are equipped with computers, live EKG screens and headphones. With immediate access to the hospital's order-entry system, camera feeds to the rooms, nursing documentation and a trend-alert screen to tell them of unusual activity in patient vital signs, staff members can monitor up to 225 ICU patients.

Swann, the nurse manager for both the MAXcare eICU and the medical/surgical ICU at St. Joseph's, has trained all staff members on the new system.

St. Joseph's is the first hospital in Georgia to install the cutting-edge system.

"When they first heard about it, nurses thought it might be like 'Big Brother' looking over their shoulders at the bedside, and that the hospital might raise nurse/patient ratios," Swann said. "Neither has been the case. We can't listen or see into the room unless the camera is turned on, and the ratios have stayed the same."

The MAXcare eICU system provides an extra pair of eyes to help bedside nurses.

"It's an extra level of safety and care for our patients," Swann said.

A unit nurse can hit the eLert button in each room if he or she has a question or needs a consultation. The camera comes on and eRNs — nurses who work in the remote eICU site — can zoom in to evaluate the patient or view a live EKG screen to check heart rate and blood-pressure readings. All the nurses have access to electronic charts, but eRNs can view EKG readings from the previous six hours and have access to an electronic database of medications, diseases and symptoms.

At night, a physician works in the eICU and can place STAT orders — orders for lifesaving drugs that require immediate use — or call the attending physician. It's a collaborative effort between ICU bedside nurses and nurses stationed in the remote eICU monitoring center.

"One patient watching the nurse talk to a disembodied voice said, 'If you're talking to God, I want my turn,'" Swann said.

While the backup system isn't infallible, it can help resolve patient issues before they become critical.

"The system is designed to ensure that patients receive evidence-based medicine and protocols to help decrease ventilator days, ventilator-associated pneumonia rates, blood stream infection rates, ICU length of stay and mortality [rates]," Swann said.

Two doctors at Johns Hopkins Hospital in Baltimore designed the system as an answer to an increasing shortage of ICU doctors and nurses.

"I think it's good to have backup," said Daisy Golden, a medical/surgical ICU nurse who also works in the eICU at St. Joseph's.

On days when Golden, RN, CCRN, ADN, isn't caring for patients, she "has more time to investigate lab or test results and try to put the puzzle together of a complicated case. It's a collaborative effort. We have access to everything [records] but the patient, and we're still using our critical-thinking skills."

Working in the eICU has given Jeff Greene, RN, a greater appreciation for the intensive-care unit.

"When you're a bedside nurse, you're concerned with your own patients," he said. "Being able to zoom in and assist with all patients builds rapport and increases communication with the staff. Communication is key to making this system effective."

Soon after the system went live, a patient slumped over and cut off the oxygen to her tracheotomy tube.

"A bell went off in the eICU and we immediately called the nurse and prevented the patient from coding," Swann said. "We expect to see a drop in coding, and, when there is a code and everyone rushes to one room, the remote staff can keep an eye on the other patients."

Most families of patients are grateful for the system.

"They feel more comfortable going home at night, knowing that someone is constantly monitoring their loved ones," Swann said.

According to data collected by a predictive prognostic system, mortality outcomes have improved.

"The APACHE III system compares a patient's medical profile against 18,000 cases and develops a prognosis that is, on average, 95 percent accurate," Swann said. "Our ICU outcomes have been better than expected. We've saved 57 more lives than they predicted we would."

St. Joseph's has plans to offer to help monitor intensive care units in outlying hospitals.

"Rural hospitals may not have a pulmonary cardiologist on staff. If we could educate and assist their critical-care staffs, they might not have to transfer patients," Swann said. "I'm excited about the possibilities. This is a great way to maximize limited resources."