The Doctor Is In, Online

When Sutter Health critical-care physician Dr. Daniel Ikeda first began working in Sutter's electronic ICU several months ago, one of the biggest adjustments was how quiet and "serene" the remote monitoring center was, compared to the noise, commotion, crying and odors in a "real" intensive care unit.

Although doctors assigned to eICU duty are responsible for monitoring more patients than they would normally check during bedside patient rounds, "the eICU is less stressful," says Ikeda, medical director of Sutter's online intensive care unit. "I can't run over to the patient, but I can push a button to get someone at the bedside quickly."

At Sutter, each eICU physician is teamed with a critical-care nurse and clerk. Both doctor and nurse monitor 35 to 50 ICU patients, and the clerk helps contact on-floor nurses or to call specialists in case a patient requires bedside assistance or emergency intervention.

Sutter is aiming to help balance critical-care doctors' time between on-site patient care at the bedside and remote monitoring of patients. Sutter's eICU doctors are scheduled to do two 12-hour shifts per week, with the remaining three days of the week set aside for making traditional onsite rounds at the units.

Without an eICU, typically critical-care doctors spend each day making rounds to five to 10 patients at the bedside, in which they analyze a patient's situation and create care plans for 6 to 24 hour increments, Ikeda says.

In traditional ICU settings, "Once I'm out of the hospital, throughout the day, ICU patients count on the ability of the nurses to inform the doctor that something bad is happening," he says. "But when I'm in the eICU I can monitor how a patient is doing for long stretches, and watch how a patient is responding over hours, to increased IV fluids or other treatment," he says. "A lot of my time is spent troubleshooting problems in unstable patients." The remote-operated camera at each ICU bed lets Ikeda zoom in to check the facial expression of a patient in pain, or even to check the drip rate of an IV tube, he say. For patient privacy, the cameras are focused on the wall when a troubled patient isn't being observed. A doorbell-like sound chimes in the patient's room to warn him or her that the camera is being turned on.

The combination of time in the eICU and time at the patient bedside has had positive effects on Ikeda's quality-of-life, he says. Since there's always a critical-care doctor staffing the Sutter eICU, "that means I get fewer calls at home when I'm on call."

Sutter Health's CIO John Hummel says that perk helps when Sutter hospitals try to recruit new ICU doctors. "Being able to tell doctors about how the eICU can help give them a better quality of life certainly makes the job more attractive," he says.

And with a national shortage of critical-care doctors, the possibility of fewer 2 a.m. wake-up calls may be just what the doctor ordered.

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